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Maity A, Wang AW, Dreier MJ, Wallace V, Orchard F, Schleider JL, Loades ME, Hamilton JL. How do adolescents experience a newly developed Online Single Session Sleep Intervention? A Think-Aloud Study. Clin Child Psychol Psychiatry 2024; 29:1137-1158. [PMID: 37978949 PMCID: PMC11188559 DOI: 10.1177/13591045231205475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Sleep problems are common in adolescents and have detrimental impacts on physical and mental health and daily functioning. Evidence-based treatment like cognitive behaviour therapy for insomnia (CBT-I) is often hard to access, and adolescents may not engage in and adhere to longer, clinician-delivered interventions. Brief, self-guided, and accessible sleep interventions are needed. OBJECTIVE To explore the user experience of a prototype online self-help single session sleep intervention developed for adolescents. METHODS Eleven participants aged 17-19 years (8 females, 3 males) took part in online retrospective think-aloud interviews. Participants first completed the prototype intervention independently and were then shown the intervention page by page and asked to verbalise their thoughts and experiences. Transcripts were analyzed thematically. RESULTS Participants found the intervention helpful. Four themes were generated - 'Educative: Learning, but more fun', 'Effortless: Quicker and Easier', 'Personalization: Power of Choice', and 'Positivity: Just Good Vibes'. The theme 'Educative: Learning, but more fun' encompassed two sub-themes 'Opportunity to Learn' and 'Aesthetics and Learning'. These themes reflected participants' views that the intervention was educative, personalised, solution-oriented and easy to use, but could incorporate more graphics and visuals to aid in learning and could be made more effortless and positive through modifications to its design. CONCLUSIONS Findings convey the importance of ensuring educative well-designed content, personalization, a positive tone, and ease of use while designing interventions targeting adolescents's sleep and mental health. They also indicate areas for further developing the intervention.
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Affiliation(s)
- Ananya Maity
- Department of Psychology, University of Bath, Bath, UK
| | - Angela W Wang
- Department of Psychology, Rutgers University, New Brunswick, USA
| | - Melissa J Dreier
- Department of Psychology, Rutgers University, New Brunswick, USA
| | | | - Faith Orchard
- School of Psychology, University of Sussex, Brighton, UK
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Takeuchi H, Ishizawa T, Kishi A, Nakamura T, Yoshiuchi K, Yamamoto Y. Just-in-Time Adaptive Intervention for Stabilizing Sleep Hours of Japanese Workers: Microrandomized Trial. J Med Internet Res 2024; 26:e49669. [PMID: 38861313 PMCID: PMC11200036 DOI: 10.2196/49669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/21/2023] [Accepted: 05/08/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Sleep disturbance is a major contributor to future health and occupational issues. Mobile health can provide interventions that address adverse health behaviors for individuals in a vulnerable health state in real-world settings (just-in-time adaptive intervention). OBJECTIVE This study aims to identify a subpopulation with vulnerable sleep state in daily life (study 1) and, immediately afterward, to test whether providing mobile health intervention improved habitual sleep behaviors and psychological wellness in real-world settings by conducting a microrandomized trial (study 2). METHODS Japanese workers (n=182) were instructed to collect data on their habitual sleep behaviors and momentary symptoms (including depressive mood, anxiety, and subjective sleep quality) using digital devices in a real-world setting. In study 1, we calculated intraindividual mean and variability of sleep hours, midpoint of sleep, and sleep efficiency to characterize their habitual sleep behaviors. In study 2, we designed and conducted a sleep just-in-time adaptive intervention, which delivered objective push-type sleep feedback messages to improve their sleep hours for a subset of participants in study 1 (n=81). The feedback messages were generated based on their sleep data measured on previous nights and were randomly sent to participants with a 50% chance for each day (microrandomization). RESULTS In study 1, we applied hierarchical clustering to dichotomize the population into 2 clusters (group A and group B) and found that group B was characterized by unstable habitual sleep behaviors (large intraindividual variabilities). In addition, linear mixed-effect models showed that the interindividual variability of sleep hours was significantly associated with depressive mood (β=3.83; P=.004), anxiety (β=5.70; P=.03), and subjective sleep quality (β=-3.37; P=.03). In study 2, we found that providing sleep feedback prolonged subsequent sleep hours (increasing up to 40 min; P=.01), and this effect lasted for up to 7 days. Overall, the stability of sleep hours in study 2 was significantly improved among participants in group B compared with the participants in study 1 (P=.001). CONCLUSIONS This is the first study to demonstrate that providing sleep feedback can benefit the modification of habitual sleep behaviors in a microrandomized trial. The findings of this study encourage the use of digitalized health intervention that uses real-time health monitoring and personalized feedback.
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Affiliation(s)
- Hiroki Takeuchi
- Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Tetsuro Ishizawa
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Central Medical Support Co, Tokyo, Japan
| | - Akifumi Kishi
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Nakamura
- Institute for Datability Science, Osaka University, Osaka, Japan
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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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Peuters C, Maenhout L, Cardon G, De Paepe A, DeSmet A, Lauwerier E, Leta K, Crombez G. A mobile healthy lifestyle intervention to promote mental health in adolescence: a mixed-methods evaluation. BMC Public Health 2024; 24:44. [PMID: 38166797 PMCID: PMC10763383 DOI: 10.1186/s12889-023-17260-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND A healthy lifestyle may improve mental health. It is yet not known whether and how a mobile intervention can be of help in achieving this in adolescents. This study investigated the effectiveness and perceived underlying mechanisms of the mobile health (mHealth) intervention #LIFEGOALS to promote healthy lifestyles and mental health. #LIFEGOALS is an evidence-based app with activity tracker, including self-regulation techniques, gamification elements, a support chatbot, and health narrative videos. METHODS A quasi-randomized controlled trial (N = 279) with 12-week intervention period and process evaluation interviews (n = 13) took place during the COVID-19 pandemic. Adolescents (12-15y) from the general population were allocated at school-level to the intervention (n = 184) or to a no-intervention group (n = 95). Health-related quality of life (HRQoL), psychological well-being, mood, self-perception, peer support, resilience, depressed feelings, sleep quality and breakfast frequency were assessed via a web-based survey; physical activity, sedentary time, and sleep routine via Axivity accelerometers. Multilevel generalized linear models were fitted to investigate intervention effects and moderation by pandemic-related measures. Interviews were coded using thematic analysis. RESULTS Non-usage attrition was high: 18% of the participants in the intervention group never used the app. An additional 30% stopped usage by the second week. Beneficial intervention effects were found for physical activity (χ21 = 4.36, P = .04), sedentary behavior (χ21 = 6.44, P = .01), sleep quality (χ21 = 6.11, P = .01), and mood (χ21 = 2.30, P = .02). However, effects on activity-related behavior were only present for adolescents having normal sports access, and effects on mood only for adolescents with full in-school education. HRQoL (χ22 = 14.72, P < .001), mood (χ21 = 6.03, P = .01), and peer support (χ21 = 13.69, P < .001) worsened in adolescents with pandemic-induced remote-education. Interviewees reported that the reward system, self-regulation guidance, and increased health awareness had contributed to their behavior change. They also pointed to the importance of social factors, quality of technology and autonomy for mHealth effectiveness. CONCLUSIONS #LIFEGOALS showed mixed results on health behaviors and mental health. The findings highlight the role of contextual factors for mHealth promotion in adolescence, and provide suggestions to optimize support by a chatbot and narrative episodes. TRIAL REGISTRATION ClinicalTrials.gov [NCT04719858], registered on 22/01/2021.
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Affiliation(s)
- Carmen Peuters
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Laura Maenhout
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Annick De Paepe
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Ann DeSmet
- Faculty of Psychology, Educational Sciences and Speech Therapy, Université Libre de Bruxelles, Bruxelles, Belgium
- Department of Communication Studies, University of Antwerp, Antwerp, Belgium
| | - Emelien Lauwerier
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kenji Leta
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium.
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Neves B, Haghighi ED, Pereira HV, Costa F, Carlos JS, Ferreira D, Moreno P, Ferreira PM, Machado J, Goncalves B, Moreira JM, Leite F, da Silva NA. Impact of a wearable-based physical activity and sleep intervention in multimorbidity patients: protocol for a randomized controlled trial. BMC Geriatr 2023; 23:853. [PMID: 38097933 PMCID: PMC10720080 DOI: 10.1186/s12877-023-04511-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The benefits of physical activity (PA) and adequate sleep are well documented, and their importance strengthens with the increasing prevalence of chronic diseases and multimorbidity (MM). Interventions to promote physical activity and sleep that use commercial activity trackers may be useful non-pharmacological approaches to managing individual health; however, limited evidence exists on their use to improve physical activity in older adult patients with MM. METHODS This study aims to measure the effects of behavioral change techniques (BCTs) delivered by a wearable device on physical activity and quality of sleep (QS) in older adult patients with MM. We designed an open-label randomized controlled trial with participants recruited through primary care and a specialist outpatient clinic. Participants must be more than 65 years old, have MM, and have access to smartphones. All eligible participants will receive PA promotion content and will be randomly assigned to wear a smartwatch. The primary outcome will be the participants' PA measurement at baseline and at six months using the International Physical Activity Questionnaire - Short Form (IPAQ-SF). Secondary outcomes will include changes in the participants' frailty status, biometric measurements, quality of life, and biopsychosocial assessments. A sample size of 40 participants per arm was calculated to detect group differences, with 50 participants planned to recruit and randomize into each arm. DISCUSSION This study aims to contribute to a better understanding of PA patterns and the impact of wearable-based PA interventions in patients with MM. In addition, we aim to contribute to more knowledge about the relationship between PA patterns, Patient Reported Outcomes Measures (PROMs), and healthcare resource utilization in patients with MM. To achieve this, the study will leverage a locally developed PROMs registry and assess data from participants' medical records, in order to understand the added impact of wearable data and medical information data on predicting PROMs and unplanned hospital admissions. TRIAL REGISTRATION NCT05777291.
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Affiliation(s)
- Bernardo Neves
- Hospital da Luz Learning Health, Luz Saúde, Lisboa, Portugal.
- Internal Medicine Department, Hospital da Luz Lisboa, Luz Saúde, Lisboa, Portugal.
| | - Eduardo D Haghighi
- Internal Medicine Department, Hospital da Luz Lisboa, Luz Saúde, Lisboa, Portugal
| | - Hugo V Pereira
- Centro de Medicina Desportiva, Hospital da Luz Lisboa, Luz Saúde, Lisboa, Portugal
- CIDEFES - Centro de Investigação em Desporto, Educacao Fisica, Exercicio e Saude, Universidade Lusofona, Lisboa, Portugal
| | - Filipe Costa
- Value Based Healthcare, Luz Saúde, Lisboa, Portugal
| | - João S Carlos
- General Practice/Family Medicine Department, Hospital da Luz Lisboa, Luz Saúde, Lisboa, Portugal
| | - Daniel Ferreira
- Hospital da Luz Learning Health, Luz Saúde, Lisboa, Portugal
| | - Plinio Moreno
- Instituto de Sistemas e Robótica (ISR/IST), LARSyS, Instituto Superior Tecnico, Unviersidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal
| | - Pedro M Ferreira
- Heinz College and at the Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburg, USA
| | - Jaime Machado
- Hospital da Luz Learning Health, Luz Saúde, Lisboa, Portugal
| | - Breno Goncalves
- Hospital da Luz Learning Health, Luz Saúde, Lisboa, Portugal
| | | | - Francisca Leite
- Hospital da Luz Learning Health, Luz Saúde, Lisboa, Portugal
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Topalidis PI, Baron S, Heib DPJ, Eigl ES, Hinterberger A, Schabus M. From Pulses to Sleep Stages: Towards Optimized Sleep Classification Using Heart-Rate Variability. SENSORS (BASEL, SWITZERLAND) 2023; 23:9077. [PMID: 38005466 PMCID: PMC10674316 DOI: 10.3390/s23229077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023]
Abstract
More and more people quantify their sleep using wearables and are becoming obsessed in their pursuit of optimal sleep ("orthosomnia"). However, it is criticized that many of these wearables are giving inaccurate feedback and can even lead to negative daytime consequences. Acknowledging these facts, we here optimize our previously suggested sleep classification procedure in a new sample of 136 self-reported poor sleepers to minimize erroneous classification during ambulatory sleep sensing. Firstly, we introduce an advanced interbeat-interval (IBI) quality control using a random forest method to account for wearable recordings in naturalistic and more noisy settings. We further aim to improve sleep classification by opting for a loss function model instead of the overall epoch-by-epoch accuracy to avoid model biases towards the majority class (i.e., "light sleep"). Using these implementations, we compare the classification performance between the optimized (loss function model) and the accuracy model. We use signals derived from PSG, one-channel ECG, and two consumer wearables: the ECG breast belt Polar® H10 (H10) and the Polar® Verity Sense (VS), an optical Photoplethysmography (PPG) heart-rate sensor. The results reveal a high overall accuracy for the loss function in ECG (86.3 %, κ = 0.79), as well as the H10 (84.4%, κ = 0.76), and VS (84.2%, κ = 0.75) sensors, with improvements in deep sleep and wake. In addition, the new optimized model displays moderate to high correlations and agreement with PSG on primary sleep parameters, while measures of reliability, expressed in intra-class correlations, suggest excellent reliability for most sleep parameters. Finally, it is demonstrated that the new model is still classifying sleep accurately in 4-classes in users taking heart-affecting and/or psychoactive medication, which can be considered a prerequisite in older individuals with or without common disorders. Further improving and validating automatic sleep stage classification algorithms based on signals from affordable wearables may resolve existing scepticism and open the door for such approaches in clinical practice.
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Affiliation(s)
- Pavlos I. Topalidis
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience Salzburg (CCNS), Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (P.I.T.); (D.P.J.H.); (E.-S.E.)
| | - Sebastian Baron
- Department of Mathematics, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria
- Department of Artificial Intelligence and Human Interfaces (AIHI), Paris-Lodron University of Salzburg, 5020 Salzburg, Austria
| | - Dominik P. J. Heib
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience Salzburg (CCNS), Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (P.I.T.); (D.P.J.H.); (E.-S.E.)
- Institut Proschlaf, 5020 Salzburg, Austria
| | - Esther-Sevil Eigl
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience Salzburg (CCNS), Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (P.I.T.); (D.P.J.H.); (E.-S.E.)
| | - Alexandra Hinterberger
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience Salzburg (CCNS), Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (P.I.T.); (D.P.J.H.); (E.-S.E.)
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience Salzburg (CCNS), Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (P.I.T.); (D.P.J.H.); (E.-S.E.)
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Lin X, Martinengo L, Jabir AI, Ho AHY, Car J, Atun R, Tudor Car L. Scope, Characteristics, Behavior Change Techniques, and Quality of Conversational Agents for Mental Health and Well-Being: Systematic Assessment of Apps. J Med Internet Res 2023; 25:e45984. [PMID: 37463036 PMCID: PMC10394504 DOI: 10.2196/45984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/05/2023] [Accepted: 06/20/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Mental disorders cause substantial health-related burden worldwide. Mobile health interventions are increasingly being used to promote mental health and well-being, as they could improve access to treatment and reduce associated costs. Behavior change is an important feature of interventions aimed at improving mental health and well-being. There is a need to discern the active components that can promote behavior change in such interventions and ultimately improve users' mental health. OBJECTIVE This study systematically identified mental health conversational agents (CAs) currently available in app stores and assessed the behavior change techniques (BCTs) used. We further described their main features, technical aspects, and quality in terms of engagement, functionality, esthetics, and information using the Mobile Application Rating Scale. METHODS The search, selection, and assessment of apps were adapted from a systematic review methodology and included a search, 2 rounds of selection, and an evaluation following predefined criteria. We conducted a systematic app search of Apple's App Store and Google Play using 42matters. Apps with CAs in English that uploaded or updated from January 2020 and provided interventions aimed at improving mental health and well-being and the assessment or management of mental disorders were tested by at least 2 reviewers. The BCT taxonomy v1, a comprehensive list of 93 BCTs, was used to identify the specific behavior change components in CAs. RESULTS We found 18 app-based mental health CAs. Most CAs had <1000 user ratings on both app stores (12/18, 67%) and targeted several conditions such as stress, anxiety, and depression (13/18, 72%). All CAs addressed >1 mental disorder. Most CAs (14/18, 78%) used cognitive behavioral therapy (CBT). Half (9/18, 50%) of the CAs identified were rule based (ie, only offered predetermined answers) and the other half (9/18, 50%) were artificial intelligence enhanced (ie, included open-ended questions). CAs used 48 different BCTs and included on average 15 (SD 8.77; range 4-30) BCTs. The most common BCTs were 3.3 "Social support (emotional)," 4.1 "Instructions for how to perform a behavior," 11.2 "Reduce negative emotions," and 6.1 "Demonstration of the behavior." One-third (5/14, 36%) of the CAs claiming to be CBT based did not include core CBT concepts. CONCLUSIONS Mental health CAs mostly targeted various mental health issues such as stress, anxiety, and depression, reflecting a broad intervention focus. The most common BCTs identified serve to promote the self-management of mental disorders with few therapeutic elements. CA developers should consider the quality of information, user confidentiality, access, and emergency management when designing mental health CAs. Future research should assess the role of artificial intelligence in promoting behavior change within CAs and determine the choice of BCTs in evidence-based psychotherapies to enable systematic, consistent, and transparent development and evaluation of effective digital mental health interventions.
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Affiliation(s)
- Xiaowen Lin
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Laura Martinengo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Ahmad Ishqi Jabir
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Andy Hau Yan Ho
- Psychology Programme, School of Social Sciences, Nanyang Technological University Singapore, Singapore, Singapore
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, United States
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Singh B, Olds T, Brinsley J, Dumuid D, Virgara R, Matricciani L, Watson A, Szeto K, Eglitis E, Miatke A, Simpson CEM, Vandelanotte C, Maher C. Systematic review and meta-analysis of the effectiveness of chatbots on lifestyle behaviours. NPJ Digit Med 2023; 6:118. [PMID: 37353578 DOI: 10.1038/s41746-023-00856-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 06/01/2023] [Indexed: 06/25/2023] Open
Abstract
Chatbots (also known as conversational agents and virtual assistants) offer the potential to deliver healthcare in an efficient, appealing and personalised manner. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of chatbot interventions designed to improve physical activity, diet and sleep. Electronic databases were searched for randomised and non-randomised controlled trials, and pre-post trials that evaluated chatbot interventions targeting physical activity, diet and/or sleep, published before 1 September 2022. Outcomes were total physical activity, steps, moderate-to-vigorous physical activity (MVPA), fruit and vegetable consumption, sleep quality and sleep duration. Standardised mean differences (SMD) were calculated to compare intervention effects. Subgroup analyses were conducted to assess chatbot type, intervention type, duration, output and use of artificial intelligence. Risk of bias was assessed using the Effective Public Health Practice Project Quality Assessment tool. Nineteen trials were included. Sample sizes ranged between 25-958, and mean participant age ranged between 9-71 years. Most interventions (n = 15, 79%) targeted physical activity, and most trials had a low-quality rating (n = 14, 74%). Meta-analysis results showed significant effects (all p < 0.05) of chatbots for increasing total physical activity (SMD = 0.28 [95% CI = 0.16, 0.40]), daily steps (SMD = 0.28 [95% CI = 0.17, 0.39]), MVPA (SMD = 0.53 [95% CI = 0.24, 0.83]), fruit and vegetable consumption (SMD = 0.59 [95% CI = 0.25, 0.93]), sleep duration (SMD = 0.44 [95% CI = 0.32, 0.55]) and sleep quality (SMD = 0.50 [95% CI = 0.09, 0.90]). Subgroup analyses showed that text-based, and artificial intelligence chatbots were more efficacious than speech/voice chatbots for fruit and vegetable consumption, and multicomponent interventions were more efficacious than chatbot-only interventions for sleep duration and sleep quality (all p < 0.05). Findings from this systematic review and meta-analysis indicate that chatbot interventions are efficacious for increasing physical activity, fruit and vegetable consumption, sleep duration and sleep quality. Chatbot interventions were efficacious across a range of populations and age groups, with both short- and longer-term interventions, and chatbot only and multicomponent interventions being efficacious.
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Affiliation(s)
- Ben Singh
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia.
| | - Timothy Olds
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Jacinta Brinsley
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Dot Dumuid
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Rosa Virgara
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Lisa Matricciani
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Amanda Watson
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Kimberley Szeto
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Emily Eglitis
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Aaron Miatke
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Catherine E M Simpson
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Corneel Vandelanotte
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Carol Maher
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
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9
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Murray JM, Magee M, Giliberto ES, Booker LA, Tucker AJ, Galaska B, Sibenaller SM, Baer SA, Postnova S, Sondag TA, Phillips AJ, Sletten TL, Howard ME, Rajaratnam SM. Mobile app for personalized sleep–wake management for shift workers: A user testing trial. Digit Health 2023; 9:20552076231165972. [PMID: 37009306 PMCID: PMC10064476 DOI: 10.1177/20552076231165972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 03/10/2023] [Indexed: 04/01/2023] Open
Abstract
Objective Development of personalized sleep–wake management tools is critical to improving sleep and functional outcomes for shift workers. The objective of the current study was to test the performance, engagement and usability of a mobile app ( SleepSync) for personalized sleep–wake management in shift workers that aid behavioural change and provide practical advice by providing personalized sleep scheduling recommendations and education. Methods Shift workers ( n = 27; 20 healthcare and 7 from other industries) trialled the mobile app for two weeks to determine performance, engagement and usability. Primary outcomes were self-reported total sleep time, ability to fall asleep, sleep quality and perception of overall recovery on days off. Secondary performance outcomes included sleep disturbances (insomnia and sleep hygiene symptoms, and sleep-related impairments) and mood (anxiety, stress and depression) pre- and post-app use. Satisfaction with schedule management, integration into daily routine and influence on behaviour were used to determine engagement, while the usability was assessed for functionality and ease of use of features. Results Total sleep time ( P = .04), ability to fall asleep ( P < .001), quality of sleep ( P = .001), insomnia ( P = .02), sleep hygiene ( P = .01), sleep-related impairments ( P = .001), anxiety ( P = .001), and stress ( P = .006) were all improved, with non-significant improvements in recovery on days off ( P = .19) and depression ( P = .07). All measures of engagement and usability were scored positively by the majority of users. Conclusions This pilot trial provides preliminary evidence of the positive impact of the SleepSync app in improving sleep and mood outcomes in shift workers, and warrants confirmation in a larger controlled trial.
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Affiliation(s)
- Jade M. Murray
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, Australia
| | - Michelle Magee
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, Australia
| | - Emma S. Giliberto
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, Australia
| | - Lauren A. Booker
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Andrew J. Tucker
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, Australia
| | - Beth Galaska
- Philips RS North America LLC f/k/a Respironics Inc, Murrysville, USA
| | | | - Sharon A. Baer
- Philips RS North America LLC f/k/a Respironics Inc, Murrysville, USA
| | - Svetlana Postnova
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, Australia
- School of Physics, University of Sydney, Sydney, Australia
| | | | - Andrew J.K. Phillips
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, Australia
| | - Tracey L. Sletten
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, Australia
| | - Mark E. Howard
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Shantha M.W. Rajaratnam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, Australia
- Shantha M.W. Rajaratnam, Turner Institute for Brain and Mental Health, School of Psychological Sciences, 18 Innovation Walk, Monash University, Clayton, Victoria 3800, Australia.
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10
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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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11
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Jahrami H, Trabelsi K, Vitiello MV, BaHammam AS. The Tale of Orthosomnia: I Am so Good at Sleeping that I Can Do It with My Eyes Closed and My Fitness Tracker on Me. Nat Sci Sleep 2023; 15:13-15. [PMID: 36713639 PMCID: PMC9875581 DOI: 10.2147/nss.s402694] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Affiliation(s)
- Haitham Jahrami
- Department of Psychiatry, Ministry of Health, Manama, Kingdom of Bahrain.,Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, 3000, Tunisia.,Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax, 3000, Tunisia
| | - Michael V Vitiello
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Ahmed S BaHammam
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia.,The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
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