1
|
Thomassen EEK, Berg IJ, Kristianslund EK, Tveter AT, Bakland G, Gossec L, Hakim S, Macfarlane GJ, de Thurah A, Østerås N. Patients with axial spondyloarthritis reported willingness to use remote care and showed high adherence to electronic patient-reported outcome measures: an 18-month observational study. Rheumatol Int 2024:10.1007/s00296-024-05673-7. [PMID: 39164589 DOI: 10.1007/s00296-024-05673-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/27/2024] [Indexed: 08/22/2024]
Abstract
Remote monitoring using electronic patient reported outcomes (ePROs) in axial spondyloarthritis (axSpA) may improve self-management and reduce the need for consultations. However, knowledge regarding patients' willingness to use remote care and adherence to reporting ePROs is scarce. The objective of this study was to assess axSpA patients' willingness to use remote care and adherence to reporting of ePROs. The study was part of a three-armed randomized controlled trial testing digital follow-up strategies (The ReMonit study, NCT: 05031767). AxSpA patients in low disease activity were randomized to usual care, remote monitoring, or patient-initiated care. Demographics, clinical data, and patients' willingness to use remote care were collected at baseline. EPROs were reported either monthly or quarterly by the remote monitoring- and patient-initiated care group over 18 months, respectively. Adherence to reporting was calculated as number of ePROs completed divided by the total number requested. Mixed model logistic regression was utilized to assess factors associated with adherence to reporting of ePROs. In total 242 patients (median age 43 years, 75% males) were included. The majority (96%) reported high willingness to use remote care. Adherence to reporting ePROs remained high over 18 months by remote monitoring and patient-initiated care groups [median (IQR): 88% (77-100) vs. 83% (66-100)]. No patient characteristics were significantly associated with adherence to reporting of ePROs. The high degree of willingness and adherence to reporting ePROs over time indicates that the majority of axSpA patients with low disease activity are motivated to use remote care.
Collapse
Affiliation(s)
- Emil Eirik Kvernberg Thomassen
- Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
- Faculty of Medicine, University of Oslo (UiO), Oslo, Norway.
| | - Inger Jorid Berg
- Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Klami Kristianslund
- Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Therese Tveter
- Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of North Norway, Tromsø, Norway
- Institute of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Tromsø, Tromsø, Norway
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Rheumatology Department Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Sarah Hakim
- Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Gary John Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nina Østerås
- Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo (UiO), Oslo, Norway
| |
Collapse
|
2
|
Goodwin S, Nastasi JA, Newman ST, Rapoza D, Raiff BR. Feasibility and Acceptability of a Mobile Game to Support Smoking Cessation: Repeated Measures Study. JMIR Serious Games 2024; 12:e54684. [PMID: 39167443 DOI: 10.2196/54684] [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: 11/18/2023] [Revised: 03/15/2024] [Accepted: 04/16/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Approximately half of smokers attempt to quit, but 90% of these attempts fail. Video game-based interventions have the potential to address common barriers to evidence-based smoking cessation treatment, including high cost, lack of health care access, and low engagement. OBJECTIVE The purpose of this study was to evaluate the feasibility and acceptability of a video game-based smoking cessation intervention called Inspired and its impact on the 7-day smoking point prevalence at the 30-day follow-up. METHODS US adults (n=48) were recruited via the web to use Inspired on their smartphones for 7 weeks. The object of the game was to defend a healing tree against attackers. Levels of the game were unlocked twice daily when participants self-reported the number of cigarettes they smoked since the previous entry. Completion of the levels awarded players in-game currency, which could strengthen in-game abilities. Participants received additional in-game rewards to aid gameplay by submitting either smoking self-reports only or self-reports indicating abstinence, determined through random assignment. In addition, participants completed a web-based survey at intake, week 4, week 7, and the 30-day follow-up. RESULTS Of the 48 participants, who had an average age of 39.8 (SD 10.7) years, 27 (56%) were female, 4 (8%) Hispanic, 37 (77%) White, and 27 (56%) employed; 26 (54%) earned CONCLUSIONS These results support the acceptability of Inspired. Although high dropout rates prevent conclusions on feasibility, a subset of the participants responded favorably. Scalable and accessible video game-based smoking cessation interventions could be the key to addressing the foremost cause of preventable morbidity and mortality in the United States. TRIAL REGISTRATION ClinicalTrials.gov NCT03929003; https://clinicaltrials.gov/ct2/show/NCT03929003.
Collapse
Affiliation(s)
- Shelby Goodwin
- Department of Psychology, College of Science and Mathematics, Rowan University, Glassboro, NJ, United States
| | - Jessica A Nastasi
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - Schyler T Newman
- Department of Psychology, University of Missouri, St. Louis, MO, United States
| | - Darion Rapoza
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Entertainment Science, Inc, Durham, NC, United States
| | - Bethany R Raiff
- Department of Psychology, College of Science and Mathematics, Rowan University, Glassboro, NJ, United States
| |
Collapse
|
3
|
Solberg Nes L, Børøsund E, Varsi C, Eide H, Waxenberg LB, Weiss KE, Morrison EJ, Støle HS, Kristjansdottir ÓB, Bostrøm K, Strand EB, Hagen MCS, Stubhaug A, Schreurs KM. Living well with chronic pain: a 12-month randomized controlled trial revealing impact from the digital pain self-management program EPIO. Pain Rep 2024; 9:e1174. [PMID: 38962688 PMCID: PMC11221858 DOI: 10.1097/pr9.0000000000001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction Chronic pain affects a wide range of physical and psychological aspects of life for those impacted. Psychosocial treatment approaches may be of support, but outreach is still limited. Objectives To evaluate the efficacy of EPIO, an evidence-informed, user-centered digital self-management intervention for people with chronic pain, in a 12-month randomized controlled trial. Methods People living with chronic pain (N = 266) were randomized to the EPIO intervention (n = 132) or a usual-care control group (n = 134). The intervention was delivered in a simple blended care model, and outcome measures collected at baseline, 6 months, and 12 months. Generalized linear models for repeated measures were fitted to compare groups over time. Results Participants were primarily female (81%), median age 49 years (range 22-78), with heterogeneous pain conditions, and had lived with pain >5 years (77.6%). A mixed linear model with all timepoints included revealed no statistically significant group differences for the primary outcome of pain interference. Significant psychological benefits in favor of the intervention group were however detected for depression (P = 0.022), self-regulatory fatigue (P = 0.024), vitality (P = 0.016), and mental health (P = 0.047). Baseline to 12-month changes showed additional favorable effects for anxiety (between-group mean differences [MDs] = 0.79, P = 0.047), depression (MD = 1.08, P = 0.004), self-regulatory fatigue (MD = 2.42, P = 0.021), pain catastrophizing (MD = 2.62, P = 0.009), and health-related quality of life. Conclusions The EPIO program aims to improve outreach of evidence-based pain self-management interventions. Findings demonstrate how using EPIO can lead to sustainable psychological change, enhancing mental health and health-related quality of life for people suffering from pain, providing a chance to live well with the pain.
Collapse
Affiliation(s)
- Lise Solberg Nes
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Elin Børøsund
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Cecilie Varsi
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hilde Eide
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Lori B. Waxenberg
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Karen E. Weiss
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Eleshia J. Morrison
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Hanne Stavenes Støle
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Ólöf B. Kristjansdottir
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
- Mental Health Team West, Primary Care of the Capital Area, Reykjavik, Iceland
| | - Katrine Bostrøm
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
| | - Elin Bolle Strand
- Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
- Institute of Health, Faculty of Health Science, VID—Scientific University, Oslo, Norway
| | | | - Audun Stubhaug
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway
| | - Karlein M.G. Schreurs
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
| |
Collapse
|
4
|
Wedel N, Zinger N, Singh AK, Kaur S, Njeze O, Cosar E, Mowrey W, Green S, Reznik M, Feldman J, Su Z, Ansari A, Elrington C, Mathur M, Zheng K, Jariwala SP. ASTHMAXcel PRO patient satisfaction and usability field testing. J Asthma 2024; 61:813-822. [PMID: 38226774 DOI: 10.1080/02770903.2024.2304615] [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: 11/06/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
Background: ASTHMAXcel PRO, an enhanced version of the ASTHMAXcel mobile application, has been developed to deliver comprehensive, guideline-based asthma education while also facilitating the collection of patient-reported outcomes (PROs) and enhancing user experience. Objective: To perform field testing and conduct formative and summative evaluation of the ASTHMAXcel PRO application to assess its impact on patient satisfaction, usability, and usage. Methods: Twenty-eight adult patients completed a baseline visit during which ASTHMAXcel PRO was introduced, health literacy was assessed, and demographic data were collected. They were instructed to use the app for 4 weeks. The Questionnaire for User Interface Satisfaction (QUIS) and the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire were administered at baseline and 4 weeks to assess user satisfaction and technology acceptance, respectively. Semi-structured interviews were conducted to gather feedback regarding the application from patients. Results: The baseline total scores were high for both UTAUT and QUIS (mean (SD): 64.2 (10.1), 6.8 (2.2) respectively) indicating that user satisfaction and acceptance began at high levels. UTAUT total score, as well as all domain scores, improved significantly from baseline to 4 weeks (p < 0.02). QUIS total score along with several domain scores (screen, system capabilities, usability) also increased from baseline to 4-weeks (p = 0.03, 0.01, 0.03, 0.01, respectively). These improvements remained significant when adjusting for age, gender, education, and health literacy. Patients reported that the application was helpful, informative, and easy to understand and use. Conclusion: The significant increases in satisfaction and technology adoption observed among ASTHMAXcel PRO users demonstrate that the application is viable and has the potential to improve upon usability challenges faced by existing mobile health applications.
Collapse
Affiliation(s)
- Nicole Wedel
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Nicole Zinger
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Anjani K Singh
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Savneet Kaur
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Obumneme Njeze
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Emine Cosar
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Wenzhu Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Samuel Green
- Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marina Reznik
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Jonathan Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Montefiore Medical Group, Montefiore Medical Center, Bronx, NY, USA
| | - Zhaoyuan Su
- Department of Informatics, University of CA Irvine, Irvine, CA, USA
| | - Asif Ansari
- Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carol Elrington
- Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Manuja Mathur
- Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kai Zheng
- Department of Informatics, University of CA Irvine, Irvine, CA, USA
| | - Sunit P Jariwala
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
5
|
Wu YC, Shen SF, Chen LK, Tung HH. A Web-Based Resilience-Enhancing Program to Improve Resilience, Physical Activity, and Well-being in Geriatric Population: Randomized Controlled Trial. J Med Internet Res 2024; 26:e53450. [PMID: 39052335 PMCID: PMC11310648 DOI: 10.2196/53450] [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: 10/07/2023] [Revised: 11/27/2023] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Resilience is a protective factor in healthy aging, helping to maintain and recover physical and mental functions. The Resilience in Illness Model has proven effective in fostering resilience and well-being. Physical activity is crucial for older adults' independence and well-being, even as aging causes a progressive decline. Additionally, older adults face challenges such as spousal loss and physical disability, making preventive intervention strategies necessary. OBJECTIVE This study aims to develop and evaluate a web-based program to enhance resilience, physical activity, and well-being among community-dwelling older adults. Additionally, we aim to gather feedback on the program's strengths and limitations. METHODS A 4-week resilience-enhancing program was created, incorporating role-play and talk-in-interaction and focusing on 3 key skills: coping, control belief, and manageability. The program included scenarios such as becoming widowed and suffering a stroke, designed to engage older adults. A pilot test preceded the intervention. As a result of the COVID-19 pandemic, the program shifted from in-person to web-based sessions. A single-blind, parallel-group, randomized controlled trial was conducted. Participants aged over 65 years were recruited offline and randomly assigned to either an intervention or control group. A certified resilience practitioner delivered the program. Outcomes in resilience, physical activity, and well-being were self-assessed at baseline (T0), 4 weeks (T1), and 12 weeks (T2) after the program. A mixed methods approach was used to evaluate feedback. RESULTS A web-based participatory program enhancing 3 skills-coping, control belief, and manageability for resilience-was well developed. Among 96 participants, 63 were randomized into the intervention group (n=31) and the control group (n=32). The mean age in the intervention group was 69.27 (SD 3.08) years and 74.84 (SD 6.23) years in the control group. Significant between-group differences at baseline were found in age (t45.6=-4.53, P<.001) and physical activity at baseline (t61=2.92, P=.005). No statistically significant between-group differences over time were observed in resilience (SE 7.49, 95% CI -10.74 to 18.61, P=.60), physical activity (SE 15.18, 95% CI -24.74 to 34.74, P=.74), and well-being (SE 3.74, 95% CI -2.68 to 11.98, P=.21) after controlling for baseline differences. The dropout rate was lower in the intervention group (2/31, 6%) compared with the control group (5/32, 16%). Moreover, 77% (24/31) of participants in the intervention group completed the entire program. Program feedback from the participants indicated high satisfaction with the web-based format and mentorship support. CONCLUSIONS This study demonstrated that a web-based resilience-enhancing program is appropriate, acceptable, feasible, and engaging for community-dwelling older adults. The program garnered enthusiasm for its potential to optimize resilience, physical activity, and well-being, with mentorship playing a crucial role in its success. Future studies should aim to refine program content, engagement, and delivery methods to effectively promote healthy aging in this population. TRIAL REGISTRATION ClinicalTrials.gov NCT05808491; https://clinicaltrials.gov/ct2/show/NCT05808491.
Collapse
Affiliation(s)
- Yi-Chen Wu
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
| | - Shu-Fen Shen
- Department of Nursing, Mackay Medical College, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
| | - Heng-Hsin Tung
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Nursing,National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
6
|
Pathipati MP, Scott LL, Griser AC, Staller K. Real-world outcomes for a digital prescription mobile application for adults with irritable bowel syndrome. Neurogastroenterol Motil 2024; 36:e14811. [PMID: 38689434 DOI: 10.1111/nmo.14811] [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] [Received: 11/27/2023] [Revised: 03/28/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Mahana™ IBS is a Food and Drug Administration-cleared prescription mobile application designed to deliver 3 months of gut-directed cognitive behavioral therapy (CBT) to adults ≥22 years old with irritable bowel syndrome (IBS). We assessed whether gut-directed CBT delivered digitally improved outcomes in IBS management. METHODS We studied users who had a dispensed physician prescription for Mahana™ IBS between August 2021 and August 2023. The primary outcome was change in IBS symptom severity (IBS-SSS) score. KEY RESULTS For the 843 patients, 324 (38%) completed half of the program up to session 5, and 162 (19%) of participants completed the full program up to session 10. Median age was 41 years, median IBS-SSS was 270 (moderate severity), IBS-mixed subtype was most common (23%) followed by IBS-C (20%) and IBS-D (19%). The change in IBS-SSS was -81.0 (p = < 0.001) after session 5 and - 104.4 (p = < 0.001) after session 10. In multivariate analyses, a higher baseline IBS-SSS (OR 1.59; 95% CI 1.26-2.01) and high baseline Perceived Stress Scale (PSS) score predicted non-response (OR 0.95; 95% CI 0.91-0.98) while older age (OR 1.10 per decade; 95% CI 1.01-1.20), prescription source from a healthcare provider (as opposed to third party telehealth encounter, OR 1.48; 95% CI 1.07-2.05), and payment for the app (OR 1.93; 95% CI 1.41-2.63) predicted adherence. CONCLUSIONS & INFERENCES Use of a digital mobile application for gut-directed CBT improved symptoms of IBS. Digital health applications have the potential to democratize CBT and allow integrated care to scale for patients with IBS.
Collapse
Affiliation(s)
- Mythili P Pathipati
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Nataletti S, Banerjee A, Macaluso R, Prokup S, Jayaraman A, Wong AWK. Developing a mobile exercise program for individuals with Spinal Cord Injury: Stakeholder perceptions of app features and implementation determinants. Disabil Health J 2024:101667. [PMID: 38964938 DOI: 10.1016/j.dhjo.2024.101667] [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: 02/20/2024] [Revised: 05/28/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Individuals with Spinal Cord Injury (SCI) often experience physical deconditioning, leading to long-term health challenges. While regular exercise can offer substantial health benefits, adherence to exercise guidelines among individuals with SCI is hindered by barriers such as inaccessibility. Exercise programs using the mobile application (App) tailored to individual needs present a promising solution for promoting exercise adherence among individuals with SCI. OBJECTIVE This study aimed to identify factors contributing to the successful implementation of an app-based home exercise program for individuals with SCI and gather user feedback on app preferences, functionality, and features. METHODS Guided by the Consolidated Framework for Implementation Research (CFIR), twenty-six clinicians completed an expert panel survey to rank factors influencing the implementation of an app-based intervention for increasing exercise adherence for individuals with SCI. CFIR-selected factors and app quality features obtained from the Mobile Application Rating Scale (MARS) framework were discussed in seven focus groups with 23 individuals with SCI, 6 caregivers, and 6 clinicians. RESULTS The expert survey identified adaptability, complexity, evidence strength/quality, relative advantage, knowledge/beliefs about the initiative, and execution as the key CFIR factors that affected the intervention's success. Major themes emerging from focus groups with individuals with SCI and caregivers included usability, instruction and guidelines, user-friendly interface, and clinician interaction. In contrast, clinicians mentioned themes such as the representation of the SCI population, time commitment, accessibility, and equipment. CONCLUSIONS The study highlights the significance of incorporating these determinants into future designs to develop app-based home exercise interventions for individuals with SCI.
Collapse
Affiliation(s)
- Sara Nataletti
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA.
| | - Anushua Banerjee
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Rebecca Macaluso
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Sara Prokup
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA; Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL, 60611, USA.
| | - Alex W K Wong
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA; Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| |
Collapse
|
8
|
Kilfoy A, Chu C, Krisnagopal A, Mcatee E, Baek S, Zworth M, Hwang K, Park H, Jibb L. Nurse-led remote digital support for adults with chronic conditions: A systematic synthesis without meta-analysis. J Clin Nurs 2024. [PMID: 38894583 DOI: 10.1111/jocn.17226] [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: 11/28/2023] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024]
Abstract
AIM The systematic review aims to synthesize the literature examining the effectiveness of nurse-led remote digital support on health outcomes in adults with chronic conditions. BACKGROUND Adults with chronic diseases have increased rates of mortality and morbidity and use health care resources at a higher intensity than those without chronic conditions-placing strain on the patient, their caregivers and health systems. Nurse-led digital health disease self-management interventions have potential to improve outcomes for patients with chronic conditions by facilitating care in environments other that the hospital setting. DESIGN AND METHODS We searched PubMed/MEDLINE, Embase, PsycINFO and Cochrane Central databases from inception to 7 December 2022. We included randomized controlled trials assessing the impact of nurse-led remote digital support interventions compared to usual care on health-related outcomes in adults with chronic illness. The Cochrane risk-of-bias tool was used to assess bias in studies. Outcomes were organized into four categories: self-management, clinical outcomes, health care resource use and satisfaction with care. Results are presented narratively based on statistical significance. RESULTS Forty-four papers pertaining to 40 unique studies were included. Interventions most targeted diabetes (n = 11) and cardiovascular disease (n = 8). Websites (n = 10) and mobile applications (n = 10) were the most used digital modalities. Nurses supported patients either in response to incoming patient health data (n = 14), virtual appointment (n = 8), virtual health education (n = 5) or through a combination of these approaches (n = 13). Positive impacts of nurse-led digital chronic disease support were identified in each outcome category. Mobile applications were the most effective digital modality. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE Results show that nurse-led remote digital support interventions significantly improve self-management capacity, clinical health outcomes, health care resource use and satisfaction with care. Such interventions have potential to support overall health for adults with chronic conditions in their home environments.
Collapse
Affiliation(s)
- Alicia Kilfoy
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Charlene Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Archanaa Krisnagopal
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Enoch Mcatee
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sunny Baek
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Mallory Zworth
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kyobin Hwang
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hyun Park
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Lindsay Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Schläpfer S, Schneider F, Santhanam P, Eicher M, Kowatsch T, Witt CM, Barth J. Engagement With a Relaxation and Mindfulness Mobile App Among People With Cancer: Exploratory Analysis of Use Data and Self-Reports From a Randomized Controlled Trial. JMIR Cancer 2024; 10:e52386. [PMID: 38819907 PMCID: PMC11179041 DOI: 10.2196/52386] [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: 09/06/2023] [Revised: 02/01/2024] [Accepted: 04/14/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) apps offer unique opportunities to support self-care and behavior change, but poor user engagement limits their effectiveness. This is particularly true for fully automated mHealth apps without any human support. Human support in mHealth apps is associated with better engagement but at the cost of reduced scalability. OBJECTIVE This work aimed to (1) describe the theory-informed development of a fully automated relaxation and mindfulness app to reduce distress in people with cancer (CanRelax app 2.0), (2) describe engagement with the app on multiple levels within a fully automated randomized controlled trial over 10 weeks, and (3) examine whether engagement was related to user characteristics. METHODS The CanRelax app 2.0 was developed in iterative processes involving input from people with cancer and relevant experts. The app includes evidence-based relaxation exercises, personalized weekly coaching sessions with a rule-based conversational agent, 39 self-enactable behavior change techniques, a self-monitoring dashboard with gamification elements, highly tailored reminder notifications, an educational video clip, and personalized in-app letters. For the larger study, German-speaking adults diagnosed with cancer within the last 5 years were recruited via the web in Switzerland, Austria, and Germany. Engagement was analyzed in a sample of 100 study participants with multiple measures on a micro level (completed coaching sessions, relaxation exercises practiced with the app, and feedback on the app) and a macro level (relaxation exercises practiced without the app and self-efficacy toward self-set weekly relaxation goals). RESULTS In week 10, a total of 62% (62/100) of the participants were actively using the CanRelax app 2.0. No associations were identified between engagement and level of distress at baseline, sex assigned at birth, educational attainment, or age. At the micro level, 71.88% (3520/4897) of all relaxation exercises and 714 coaching sessions were completed in the app, and all participants who provided feedback (52/100, 52%) expressed positive app experiences. At the macro level, 28.12% (1377/4897) of relaxation exercises were completed without the app, and participants' self-efficacy remained stable at a high level. At the same time, participants raised their weekly relaxation goals, which indicates a potential relative increase in self-efficacy. CONCLUSIONS The CanRelax app 2.0 achieved promising engagement even though it provided no human support. Fully automated social components might have compensated for the lack of human involvement and should be investigated further. More than one-quarter (1377/4897, 28.12%) of all relaxation exercises were practiced without the app, highlighting the importance of assessing engagement on multiple levels.
Collapse
Affiliation(s)
- Sonja Schläpfer
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Fabian Schneider
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St.Gallen, Switzerland
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| |
Collapse
|
10
|
Lubasinski N, Thabit H, Nutter PW, Harper S. What Is the Tech Missing? Nutrition Reporting in Type 1 Diabetes. Nutrients 2024; 16:1690. [PMID: 38892623 PMCID: PMC11174934 DOI: 10.3390/nu16111690] [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: 05/06/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Type 1 Diabetes (T1D) presents self-management challenges, requiring an additional 180 daily decisions to regulate blood glucose (BG) levels. Despite the potential, T1D-focused applications have a 43% attrition rate. This work delves into the willingness of people living with T1D (PwT1D) to use technology. METHOD An online questionnaire investigated the current practices for carbohydrate estimation, nutritional tracking, and attitudes towards technology engagement, along with hypothetical scenarios and preferences regarding technology use. RESULTS Thirty-nine responses were collected from PwT1D (n = 33) and caregivers (n = 6). Nutrition reporting preferences varied, with 50% favoring 'type and scroll' while 30% preferred meal photographing. Concerning the timing of reporting, 33% reported before meals, 55% after, and 12% at a later time. Improved Time in Range (TIR) was a strong motivator for app use, with 78% expressing readiness to adjust insulin doses based on app suggestions for optimizing TIR. Meal descriptions varied; a single word was used in 42% of cases, 23% used a simple description (i.e., "Sunday dinner"), 30% included portion sizes, and 8% provided full recipes. CONCLUSION PwT1D shows interest in using technology to reduce the diabetes burden when it leads to an improved TIR. For such technology to be ecologically valid, it needs to strike a balance between requiring minimal user input and providing significant data, such as meal tags, to ensure accurate blood glucose management without overwhelming users with reporting tasks.
Collapse
Affiliation(s)
- Nicole Lubasinski
- Department of Computer Science, The University of Manchester, Manchester M13 9PL, UK; (P.W.N.); (S.H.)
| | - Hood Thabit
- Diabetes, Endocrine & Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS, Manchester M13 9WL, UK;
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Science, The University of Manchester, Manchester M13 9PL, UK
| | - Paul W. Nutter
- Department of Computer Science, The University of Manchester, Manchester M13 9PL, UK; (P.W.N.); (S.H.)
| | - Simon Harper
- Department of Computer Science, The University of Manchester, Manchester M13 9PL, UK; (P.W.N.); (S.H.)
| |
Collapse
|
11
|
Willemsen RF, Chavannes NH, Aardoom JJ. Feasibility and Acceptability of a Health App Platform Providing Individuals With a Budget to Purchase Preselected Apps to Work on Their Health and Well-Being: Quantitative Evaluation Study. JMIR Form Res 2024; 8:e51408. [PMID: 38809585 PMCID: PMC11170047 DOI: 10.2196/51408] [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: 08/09/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The potential of health apps for health promotion and disease prevention is widely recognized. However, uptake is limited due to barriers individuals face in finding suitable and trustworthy apps, such as the overwhelming amount of available health apps. Therefore, the health app platform "FitKnip" was developed, enabling individuals to purchase preselected, trustworthy health apps with a budget of 100 euros (a currency exchange rate of EUR €1=US $1.0831 is applicable). The platform aimed to empower individuals to improve their health and vitality, ultimately supporting a more healthy society. OBJECTIVE The primary aim of this study was to evaluate the health app platform in terms of feasibility and acceptability. Potential effects on health empowerment and health outcomes were secondarily explored. METHODS This quantitative study was part of a mixed methods study with a prospective pre-post interventional design. We collected web-based user data, and self-reported web-based questionnaires were collected over 5 measurements over an 8-month period. Use statistics were tracked on the platform, including the number of purchased apps and euros spent per user registered within the health app platform. We measured the user-friendliness of the health app platform using the System Usability Scale (SUS) and satisfaction using the Client Satisfaction Questionnaire-8 (CSQ-8) and several 10-point Likert items. We asked participants to indicate, on a scale from 1 (not at all) to 10 (completely), how much the health app platform contributed to various areas related to health empowerment. We assessed health-related quality of life by the 12-item Short-Form Health Survey (SF-12) and one's perceived level of stress by the 10-item Perceived Stress Scale (PSS-10). RESULTS A total of 1650 participants were included, of whom 42% (685/1650) bought at least 1 app. The majority of those purchased one app (244/685, 35.6%). The health app platform was rated as user-friendly (SUS mean 66.5, SD 20.7; range 66.5-70.0), and the acceptability of the health app platform was moderate (CSQ-8 mean 20.0, SD 1.5; range 19.6-20.0). Results furthermore showed that participants were generally satisfied to highly satisfied with the ease of the payment system to purchase apps on the platform (median 8, IQR 7-10), the look and feel of the platform (median 7, IQR 6-8), as well as the provided budget of 100 euros (median 9, IQR 7-10). Participants were less satisfied with the amount (median 6, IQR 4-7) and diversity (median 6, IQR 4-7) of apps offered on the platform. CONCLUSIONS A health app platform is a promising initiative to enhance public health. Feasibility and acceptability are critical for success, as they ensure that such a platform is accessible, user-friendly, and meets end users' needs and preferences. This can help to increase uptake, engagement, and ultimately the platform's adoption and effectiveness.
Collapse
Affiliation(s)
- Romy Fleur Willemsen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Niels Henrik Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Jiska Joëlle Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
12
|
Sparks C, Hsu A, Neller SA, Eaton J, Thompson A, Wong B, Iacob E, Terrill AL, Caserta M, Stark L, Utz RL. Comparison of recruitment methodologies for clinical trials: Results from the time for living and caring (TLC) intervention study. Contemp Clin Trials 2024; 140:107518. [PMID: 38554816 PMCID: PMC11072241 DOI: 10.1016/j.cct.2024.107518] [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: 10/20/2023] [Revised: 02/29/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Recruiting participants for research studies is a critical yet challenging task. Community-engaged recruitment strategies have gained prominence as effective means to engage diverse populations and ensure the representativeness of study samples. This case study aims to investigate the cost and effectiveness of various recruitment methods in enhancing research participation. METHODS A comparative approach was employed to assess the outcomes of five different recruitment strategies used in the Time for Living & Caring (TLC) research study. Data on recruitment success, participant demographics, and retention rates were collected and analyzed using descriptive statistics, including ANOVA and Chi-squares, to statistically compare the outcomes associated with 5 different recruitment methodologies. The recruitment methodologies included two community-engaged strategies (community partner referral and community-based recruiters), a clinical database, social media, and word-of-mouth referral. CONCLUSION The meta-data used to build this methodological case study describe different recruitment methodologies that may be used for clinical trials. This data-driven evaluation provides examples and considerations for researchers when developing budgets and proposals for future clinical trials. The primary finding is that there are tradeoffs in terms of cost, time, labor, and ultimately the representativeness of the sample, based on the type of recruitment methodology chosen.
Collapse
Affiliation(s)
- Catharine Sparks
- Department of Occupational & Recreational Therapies, 520 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Anna Hsu
- College of Social & Behavioral Science, University of Utah, 260 S Central Campus Dr., Salt Lake City, UT 84112, USA
| | - Sarah A Neller
- College of Nursing, The University of Tennessee, Knoxville, 1412 Circle Dr., Knoxville, TN 37996, USA
| | - Jacqueline Eaton
- College of Nursing, University of Utah, 10 S. 2000 E, Salt Lake City, UT 84112, USA
| | - Amber Thompson
- College of Social & Behavioral Science, University of Utah, 260 S Central Campus Dr., Salt Lake City, UT 84112, USA
| | - Bob Wong
- College of Nursing, University of Utah, 10 S. 2000 E, Salt Lake City, UT 84112, USA
| | - Eli Iacob
- College of Nursing, University of Utah, 10 S. 2000 E, Salt Lake City, UT 84112, USA
| | - Alexandra L Terrill
- Department of Occupational & Recreational Therapies, 520 Wakara Way, Salt Lake City, UT 84108, USA
| | - Michael Caserta
- College of Nursing, University of Utah, 10 S. 2000 E, Salt Lake City, UT 84112, USA
| | - Louisa Stark
- School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132, USA
| | - Rebecca L Utz
- College of Social & Behavioral Science, University of Utah, 260 S Central Campus Dr., Salt Lake City, UT 84112, USA
| |
Collapse
|
13
|
Tarricone R, Petracca F, Svae L, Cucciniello M, Ciani O. Which behaviour change techniques work best for diabetes self-management mobile apps? Results from a systematic review and meta-analysis of randomised controlled trials. EBioMedicine 2024; 103:105091. [PMID: 38579364 PMCID: PMC11002812 DOI: 10.1016/j.ebiom.2024.105091] [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: 09/28/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Self-management is pivotal in addressing noncommunicable diseases, such as diabetes. The increased availability of digital behaviour change interventions (DBCIs) delivered through mobile health apps offers unprecedented opportunities to enhance self-management and improve health outcomes. However, little is known about the characteristics of DBCIs for diabetes that significantly impact glycaemic control. Therefore, our systematic review with meta-analysis aimed to summarize characteristics and behaviour change components in DBCIs for diabetes self-management and explore potential associations with metabolic outcomes. METHODS A systematic search was conducted in PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Scopus to identify randomized controlled trials published until November 2023. The main outcome variable was the change in the mean difference of HbA1c levels between baseline and follow-up across intervention and control groups. Random-effects meta-regression was used to explore variation in glycaemic control as a function of prespecified characteristics of study designs and app interventions. FINDINGS A total of 57 studies was included in the analysis, showing a statistically significant percentage point reduction in HbA1c for the intervention group compared to the control arm (-0.36, 95% CI = -0.46 to -0.26, p < 0.001). The inclusion of "self-monitoring of behaviour" as a behaviour change technique (β = -0.22, p = 0.04) and "taking medication" as a target behaviour (β = -0.20, p = 0.05) was associated with improved metabolic outcomes. INTERPRETATION Our analyses endorse the use of diabetes self-management apps, highlighting characteristics statistically associated with intervention effectiveness and guiding the design of more effective DBCIs. FUNDING This project received funding from the European Union's Horizon 2020 programme.
Collapse
Affiliation(s)
- Rosanna Tarricone
- Department of Social and Political Sciences, Bocconi University, Milan, Italy; Centre for Research on Health and Social Care Management (CERGAS), Government, Health and Not for Profit Division, SDA Bocconi School of Management, Milan, Italy
| | - Francesco Petracca
- Centre for Research on Health and Social Care Management (CERGAS), Government, Health and Not for Profit Division, SDA Bocconi School of Management, Milan, Italy.
| | - Liv Svae
- Centre for Research on Health and Social Care Management (CERGAS), Government, Health and Not for Profit Division, SDA Bocconi School of Management, Milan, Italy
| | - Maria Cucciniello
- Department of Social and Political Sciences, Bocconi University, Milan, Italy; Centre for Research on Health and Social Care Management (CERGAS), Government, Health and Not for Profit Division, SDA Bocconi School of Management, Milan, Italy
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management (CERGAS), Government, Health and Not for Profit Division, SDA Bocconi School of Management, Milan, Italy
| |
Collapse
|
14
|
Monachelli R, Davis SW, Barnard A, Longmire M, Docherty JP, Oakley-Girvan I. Designing mHealth Apps to Incorporate Evidence-Based Techniques for Prolonging User Engagement. Interact J Med Res 2024; 13:e51974. [PMID: 38416858 PMCID: PMC11005439 DOI: 10.2196/51974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/14/2023] [Accepted: 02/27/2024] [Indexed: 03/01/2024] Open
Abstract
Maintaining user engagement with mobile health (mHealth) apps can be a challenge. Previously, we developed a conceptual model to optimize patient engagement in mHealth apps by incorporating multiple evidence-based methods, including increasing health literacy, enhancing technical competence, and improving feelings about participation in clinical trials. This viewpoint aims to report on a series of exploratory mini-experiments demonstrating the feasibility of testing our previously published engagement conceptual model. We collected data from 6 participants using an app that showed a series of educational videos and obtained additional data via questionnaires to illustrate and pilot the approach. The videos addressed 3 elements shown to relate to engagement in health care app use: increasing health literacy, enhancing technical competence, and improving positive feelings about participation in clinical trials. We measured changes in participants' knowledge and feelings, collected feedback on the videos and content, made revisions based on this feedback, and conducted participant reassessments. The findings support the feasibility of an iterative approach to creating and refining engagement enhancements in mHealth apps. Systematically identifying the key evidence-based elements intended to be included in an app's design and then systematically testing the implantation of each element separately until a satisfactory level of positive impact is achieved is feasible and should be incorporated into standard app design. While mHealth apps have shown promise, participants are more likely to drop out than to be retained. This viewpoint highlights the potential for mHealth researchers to test and refine mHealth apps using approaches to better engage users.
Collapse
Affiliation(s)
| | | | | | | | - John P Docherty
- Weill Cornell Medical College, White Plains, NY, United States
| | - Ingrid Oakley-Girvan
- Medable Inc, Palo Alto, CA, United States
- The Public Health Institute, Oakland, CA, United States
| |
Collapse
|
15
|
Macrynikola N, Mir Z, Gopal T, Rodriguez E, Li S, Cox M, Yeh G, Torous J. The impact of mindfulness apps on psychological processes of change: a systematic review. NPJ MENTAL HEALTH RESEARCH 2024; 3:14. [PMID: 38609511 PMCID: PMC10955957 DOI: 10.1038/s44184-023-00048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/08/2023] [Indexed: 04/14/2024]
Abstract
Mindfulness-based interventions (MBIs) have demonstrated therapeutic efficacy for various psychological conditions, and smartphone apps that facilitate mindfulness practice can enhance the reach and impact of MBIs. The goal of this review was to summarize the published evidence on the impact of mindfulness apps on the psychological processes known to mediate transdiagnostic symptom reduction after mindfulness practice. A literature search from January 1, 1993, to August 7, 2023 was conducted on three databases, and 28 randomized controlled trials involving 5963 adults were included. Across these 28 studies, 67 outcome comparisons were made between a mindfulness app group and a control group. Between-group effects tended to favor the mindfulness app group over the control group in three psychological process domains: repetitive negative thinking, attention regulation, and decentering/defusion. Findings were mixed in other domains (i.e., awareness, nonreactivity, non-judgment, positive affect, and acceptance). The range of populations examined, methodological concerns across studies, and problems with sustained app engagement likely contributed to mixed findings. However, effect sizes tended to be moderate to large when effects were found, and gains tended to persist at follow-up assessments two to six months later. More research is needed to better understand the impact of these apps on psychological processes of change. Clinicians interested in integrating apps into care should consider app-related factors beyond evidence of a clinical foundation and use app databases to identify suitable apps for their patients, as highlighted at the end of this review.
Collapse
Affiliation(s)
- Natalia Macrynikola
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA.
| | - Zareen Mir
- Teacher's College, Columbia University, New York, NY, USA
| | | | | | - Sunnie Li
- Northeastern University, Boston, MA, USA
| | - Milann Cox
- Penn State College of Medicine, Hershey, PA, USA
| | - Gloria Yeh
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
| | - John Torous
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
| |
Collapse
|
16
|
Forman-Hoffman VL, Sihvonen S, Wielgosz J, Kuhn E, Nelson BW, Peiper NC, Gould CE. Therapist-supported digital mental health intervention for depressive symptoms: A randomized clinical trial. J Affect Disord 2024; 349:494-501. [PMID: 38211747 DOI: 10.1016/j.jad.2024.01.057] [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] [Received: 07/11/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
Depression is a chronic and debilitating mental disorder. Despite the existence of several evidence-based treatments, many individuals suffering from depression face myriad structural barriers to accessing timely care which may be alleviated by digital mental health interventions (DMHI). Accordingly, this randomized clinical trial (ClinicalTrials.gov: NCT04738084) investigated the efficacy of a newer version of the therapist-supported and guided DMHI, the Meru Health Program (MHP), which was recently enhanced with heart rate variability biofeedback and lengthened from 8- to 12-weeks duration, among people with elevated depression symptoms (N = 100, mean age 37). Recruited participants were randomized to the MHP (n = 54) or a waitlist control (n = 46) condition for 12 weeks. The MHP group had greater decreases in depression symptoms compared to the waitlist control (d = -0.8). A larger proportion of participants in the MHP group reported a minimal clinically important difference (MCID) in depression symptoms than participants in the waitlist control group (39.1 % vs. 9.8 %, χ2(1) = 9.90, p = .002). Similar effects were demonstrated for anxiety symptoms, quality of life, insomnia, and resilience. The results confirm the utility of the enhanced MHP in reducing depression symptoms and associated health burdens.
Collapse
Affiliation(s)
- Valerie L Forman-Hoffman
- Meru Health, San Mateo, CA, USA; Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | | | - Joseph Wielgosz
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Eric Kuhn
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Healthcare System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Benjamin W Nelson
- Meru Health, San Mateo, CA, USA; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nicholas C Peiper
- Meru Health, San Mateo, CA, USA; Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, USA
| | - Christine E Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.
| |
Collapse
|
17
|
Larsen E, Murton O, Song X, Joachim D, Watts D, Kapczinski F, Venesky L, Hurowitz G. Validating the efficacy and value proposition of mental fitness vocal biomarkers in a psychiatric population: prospective cohort study. Front Psychiatry 2024; 15:1342835. [PMID: 38505797 PMCID: PMC10948552 DOI: 10.3389/fpsyt.2024.1342835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/14/2024] [Indexed: 03/21/2024] Open
Abstract
Background The utility of vocal biomarkers for mental health assessment has gained increasing attention. This study aims to further this line of research by introducing a novel vocal scoring system designed to provide mental fitness tracking insights to users in real-world settings. Methods A prospective cohort study with 104 outpatient psychiatric participants was conducted to validate the "Mental Fitness Vocal Biomarker" (MFVB) score. The MFVB score was derived from eight vocal features, selected based on literature review. Participants' mental health symptom severity was assessed using the M3 Checklist, which serves as a transdiagnostic tool for measuring depression, anxiety, post-traumatic stress disorder, and bipolar symptoms. Results The MFVB demonstrated an ability to stratify individuals by their risk of elevated mental health symptom severity. Continuous observation enhanced the MFVB's efficacy, with risk ratios improving from 1.53 (1.09-2.14, p=0.0138) for single 30-second voice samples to 2.00 (1.21-3.30, p=0.0068) for data aggregated over two weeks. A higher risk ratio of 8.50 (2.31-31.25, p=0.0013) was observed in participants who used the MFVB 5-6 times per week, underscoring the utility of frequent and continuous observation. Participant feedback confirmed the user-friendliness of the application and its perceived benefits. Conclusions The MFVB is a promising tool for objective mental health tracking in real-world conditions, with potential to be a cost-effective, scalable, and privacy-preserving adjunct to traditional psychiatric assessments. User feedback suggests that vocal biomarkers can offer personalized insights and support clinical therapy and other beneficial activities that are associated with improved mental health risks and outcomes.
Collapse
Affiliation(s)
| | | | | | | | - Devon Watts
- Neuroscience Graduate Program, Department of Health Sciences, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Flavio Kapczinski
- Neuroscience Graduate Program, Department of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | |
Collapse
|
18
|
Alfaro AJ, Wielgosz J, Kuhn E, Carlson C, Gould CE. Determinants and outcome correlates of engagement with a mobile mental health intervention for depression and anxiety in middle-aged and older adults. J Clin Psychol 2024; 80:509-521. [PMID: 38157399 DOI: 10.1002/jclp.23636] [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: 02/28/2023] [Revised: 11/13/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To examine baseline factors (i.e., age, gender, mobile device proficiency, sensory impairment) associated with app engagement in a 12-week mental health app intervention and to explore whether app engagement predicts changes in depression and anxiety symptoms among middle-aged and older adults. METHOD Mobile device proficiency, sensory impairment, depression, and anxiety symptoms were measured using questionnaires. App engagement was defined by metrics characterizing the core intervention features (i.e., messages sent to therapist, mindfulness meditation minutes, action tasks completed). Multiple regressions and multilevel models were conducted. RESULTS Forty-nine participants (M age = 57.40, SD = 11.09 years) enrolled. Women (β = .35, p < .05) and participants with less sensory impairment completed more action tasks (β = -.40, p < .05). Depressive and anxiety symptoms measured within the app declined significantly across treatment. Clinical significant improvements were observed for depression in 48.9% and for anxiety in 40% of participants. App engagement metrics were not predictive of depression or anxiety symptoms, either incrementally in time-lagged models or cumulatively in hierarchical linear regression analyses. CONCLUSION App engagement is multifaceted; participants engaged differently by gender and ability. Participation in this digital mental health intervention reduced depression and anxiety symptoms, but these findings should be interpreted with caution as the study did not include a control condition. Our findings underscore the importance of considering individual factors that may influence use of a digital mental health intervention.
Collapse
Affiliation(s)
- Ana J Alfaro
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Joseph Wielgosz
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
| | - Eric Kuhn
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
| | - Chalise Carlson
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Christine E Gould
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
19
|
Björnsdottir S, Ulfsdottir H, Gudmundsson EF, Sveinsdottir K, Isberg AP, Dobies B, Akerlie Magnusdottir GE, Gunnarsdottir T, Karlsdottir T, Bjornsdottir G, Sigurdsson S, Oddsson S, Gudnason V. User Engagement, Acceptability, and Clinical Markers in a Digital Health Program for Nonalcoholic Fatty Liver Disease: Prospective, Single-Arm Feasibility Study. JMIR Cardio 2024; 8:e52576. [PMID: 38152892 PMCID: PMC10905363 DOI: 10.2196/52576] [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: 09/12/2023] [Revised: 12/15/2023] [Accepted: 12/26/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in the world. Common comorbidities are central obesity, type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome. Cardiovascular disease is the most common cause of death among people with NAFLD, and lifestyle changes can improve health outcomes. OBJECTIVE This study aims to explore the acceptability of a digital health program in terms of engagement, retention, and user satisfaction in addition to exploring changes in clinical outcomes, such as weight, cardiometabolic risk factors, and health-related quality of life. METHODS We conducted a prospective, open-label, single-arm, 12-week study including 38 individuals with either a BMI >30, metabolic syndrome, or type 2 diabetes mellitus and NAFLD screened by FibroScan. An NAFLD-specific digital health program focused on disease education, lowering carbohydrates in the diet, food logging, increasing activity level, reducing stress, and healthy lifestyle coaching was offered to participants. The coach provided weekly feedback on food logs and other in-app activities and opportunities for participants to ask questions. The coaching was active throughout the 12-week intervention period. The primary outcome was feasibility and acceptability of the 12-week program, assessed through patient engagement, retention, and satisfaction with the program. Secondary outcomes included changes in weight, liver fat, body composition, and other cardiometabolic clinical parameters at baseline and 12 weeks. RESULTS In total, 38 individuals were included in the study (median age 59.5, IQR 46.3-68.8 years; n=23, 61% female). Overall, 34 (89%) participants completed the program and 29 (76%) were active during the 12-week program period. The median satisfaction score was 6.3 (IQR 5.8-6.7) of 7. Mean weight loss was 3.5 (SD 3.7) kg (P<.001) or 3.2% (SD 3.4%), with a 2.2 (SD 2.7) kg reduction in fat mass (P<.001). Relative liver fat reduction was 19.4% (SD 23.9%). Systolic blood pressure was reduced by 6.0 (SD 13.5) mmHg (P=.009). The median reduction was 0.14 (IQR 0-0.47) mmol/L for triglyceride levels (P=.003), 3.2 (IQR 0.0-5.4) µU/ml for serum insulin (s-insulin) levels (P=.003), and 0.5 (IQR -0.7 to 3.8) mmol/mol for hemoglobin A1c (HbA1c) levels (P=.03). Participants who were highly engaged (ie, who used the app at least 5 days per week) had greater weight loss and liver fat reduction. CONCLUSIONS The 12-week-long digital health program was feasible for individuals with NAFLD, receiving high user engagement, retention, and satisfaction. Improved liver-specific and cardiometabolic health was observed, and more engaged participants showed greater improvements. This digital health program could provide a new tool to improve health outcomes in people with NAFLD. TRIAL REGISTRATION Clinicaltrials.gov NCT05426382; https://clinicaltrials.gov/study/NCT05426382.
Collapse
Affiliation(s)
- Sigridur Björnsdottir
- Department of Endocrinology, Metabolism and Diabetes, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | - Gudlaug Bjornsdottir
- Icelandic Heart Association, Kopavogur, Iceland
- School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Sigurdur Sigurdsson
- Icelandic Heart Association, Kopavogur, Iceland
- School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
20
|
Ho TQA, Le LKD, Engel L, Le N, Melvin G, Le HND, Mihalopoulos C. Barriers to and facilitators of user engagement with web-based mental health interventions in young people: a systematic review. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02386-x. [PMID: 38356043 DOI: 10.1007/s00787-024-02386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
Many young people (YP) are diagnosed with mental illnesses and require support. Web-based mental health interventions (W-MHIs) have been increasingly utilized by YP, healthcare providers, and parents due to reasons including convenience and anonymity. W-MHIs are effective in improving mental health in YP. However, real-world engagement with W-MHIs remains low. Therefore, understanding barriers/facilitators of user engagement with W-MHIs is necessary to promote W-MHIs and help users gain optimal benefits through higher engagement. This review aims to identify barriers/facilitators of user engagement with W-MHIs in YP aged 10-24 years. A systematic search of five databases for English language, peer-reviewed publications was conducted between January 2010 and February 2023. Studies examining factors influencing user engagement with W-MHIs, described as barriers or facilitators, were included. Study quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was performed. Of 4088 articles identified, 69 studies were included. Barriers/facilitators were reported by young people (63 studies), providers (17 studies), and parents/caregivers (8 studies). YP perceived that usefulness and connectedness were the most common facilitators, whereas low-perceived need was the most reported barrier. Both providers and parents reported that perceived usefulness for YP was the most common facilitator, whereas concerns about program effectiveness and privacy were noted as barriers. This review found that program- and individual-related factors were important determinants of engagement with W-MHIs. This review provides guidance on the future design and development of new interventions, narrowing the gap between existing W-MHIs and unmet needs of users.
Collapse
Affiliation(s)
- Thi Quynh Anh Ho
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia.
| | - Long Khanh-Dao Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ngoc Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Glenn Melvin
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ha N D Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
21
|
Varma N, Han JK, Passman R, Rosman LA, Ghanbari H, Noseworthy P, Avari Silva JN, Deshmukh A, Sanders P, Hindricks G, Lip G, Sridhar AR. Promises and Perils of Consumer Mobile Technologies in Cardiovascular Care: JACC Scientific Statement. J Am Coll Cardiol 2024; 83:611-631. [PMID: 38296406 DOI: 10.1016/j.jacc.2023.11.024] [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] [Received: 11/01/2023] [Accepted: 11/16/2023] [Indexed: 02/08/2024]
Abstract
Direct-to-consumer (D2C) wearables are becoming increasingly popular in cardiovascular health management because of their affordability and capability to capture diverse health data. Wearables may enable continuous health care provider-patient partnerships and reduce the volume of episodic clinic-based care (thereby reducing health care costs). However, challenges arise from the unregulated use of these devices, including questionable data reliability, potential misinterpretation of information, unintended psychological impacts, and an influx of clinically nonactionable data that may overburden the health care system. Further, these technologies could exacerbate, rather than mitigate, health disparities. Experience with wearables in atrial fibrillation underscores these challenges. The prevalent use of D2C wearables necessitates a collaborative approach among stakeholders to ensure effective integration into cardiovascular care. Wearables are heralding innovative disease screening, diagnosis, and management paradigms, expanding therapeutic avenues, and anchoring personalized medicine.
Collapse
Affiliation(s)
- Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Janet K Han
- Department of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Department of Cardiology, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA
| | - Rod Passman
- Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lindsey Anne Rosman
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Hamid Ghanbari
- Department of Cardiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Prashanthan Sanders
- Department of Cardiology, University of Adelaide, South Australia, Australia
| | | | - Gregory Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
| | - Arun R Sridhar
- Department of Cardiology, Pulse Heart Institute, Seattle, Washington, USA; Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
| |
Collapse
|
22
|
Chiauzzi E, Williams A, Mariano TY, Pajarito S, Robinson A, Kirvin-Quamme A, Forman-Hoffman V. Demographic and clinical characteristics associated with anxiety and depressive symptom outcomes in users of a digital mental health intervention incorporating a relational agent. BMC Psychiatry 2024; 24:79. [PMID: 38291369 PMCID: PMC10826101 DOI: 10.1186/s12888-024-05532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Digital mental health interventions (DMHIs) may reduce treatment access issues for those experiencing depressive and/or anxiety symptoms. DMHIs that incorporate relational agents may offer unique ways to engage and respond to users and to potentially help reduce provider burden. This study tested Woebot for Mood & Anxiety (W-MA-02), a DMHI that employs Woebot, a relational agent that incorporates elements of several evidence-based psychotherapies, among those with baseline clinical levels of depressive or anxiety symptoms. Changes in self-reported depressive and anxiety symptoms over 8 weeks were measured, along with the association between each of these outcomes and demographic and clinical characteristics. METHODS This exploratory, single-arm, 8-week study of 256 adults yielded non-mutually exclusive subsamples with either clinical levels of depressive or anxiety symptoms at baseline. Week 8 Patient Health Questionnaire-8 (PHQ-8) changes were measured in the depressive subsample (PHQ-8 ≥ 10). Week 8 Generalized Anxiety Disorder-7 (GAD-7) changes were measured in the anxiety subsample (GAD-7 ≥ 10). Demographic and clinical characteristics were examined in association with symptom changes via bivariate and multiple regression models adjusted for W-MA-02 utilization. Characteristics included age, sex at birth, race/ethnicity, marital status, education, sexual orientation, employment status, health insurance, baseline levels of depressive and anxiety symptoms, and concurrent psychotherapeutic or psychotropic medication treatments during the study. RESULTS Both the depressive and anxiety subsamples were predominantly female, educated, non-Hispanic white, and averaged 38 and 37 years of age, respectively. The depressive subsample had significant reductions in depressive symptoms at Week 8 (mean change =-7.28, SD = 5.91, Cohen's d = -1.23, p < 0.01); the anxiety subsample had significant reductions in anxiety symptoms at Week 8 (mean change = -7.45, SD = 5.99, Cohen's d = -1.24, p < 0.01). No significant associations were found between sex at birth, age, employment status, educational background and Week 8 symptom changes. Significant associations between depressive and anxiety symptom outcomes and sexual orientation, marital status, concurrent mental health treatment, and baseline symptom severity were found. CONCLUSIONS The present study suggests early promise for W-MA-02 as an intervention for depression and/or anxiety symptoms. Although exploratory in nature, this study revealed potential user characteristics associated with outcomes that can be investigated in future studies. TRIAL REGISTRATION This study was retrospectively registered on ClinicalTrials.gov (#NCT05672745) on January 5th, 2023.
Collapse
Affiliation(s)
- Emil Chiauzzi
- Woebot Health, 535 Mission Street, 14th Floor, San Francisco, CA, 94105, USA
| | - Andre Williams
- Woebot Health, 535 Mission Street, 14th Floor, San Francisco, CA, 94105, USA
| | - Timothy Y Mariano
- Woebot Health, 535 Mission Street, 14th Floor, San Francisco, CA, 94105, USA
- RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sarah Pajarito
- Woebot Health, 535 Mission Street, 14th Floor, San Francisco, CA, 94105, USA
| | - Athena Robinson
- Woebot Health, 535 Mission Street, 14th Floor, San Francisco, CA, 94105, USA
| | | | | |
Collapse
|
23
|
Rotondi AJ, Belnap BH, Rothenberger S, Feldman R, Hanusa B, Rollman BL. Predictors of Use and Drop Out From a Web-Based Cognitive Behavioral Therapy Program and Health Community for Depression and Anxiety in Primary Care Patients: Secondary Analysis of a Randomized Controlled Trial. JMIR Ment Health 2024; 11:e52197. [PMID: 38231552 PMCID: PMC10836415 DOI: 10.2196/52197] [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] [Received: 08/26/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND A previously reported study examined the treatment of primary care patients with at least moderate severity depressive or anxiety symptoms via an evidence-based computerized cognitive behavioral therapy (CCBT) program (Beating the Blues) and an online health community (OHC) that included a moderated internet support group. The 2 treatment arms proved to be equally successful at 6-month follow-up. OBJECTIVE Although highly promising, e-mental health treatment programs have encountered high rates of noninitiation, poor adherence, and discontinuation. Identifying ways to counter these tendencies is critical for their success. To further explore these issues, this study identified the primary care patient characteristics that increased the chances patients would not initiate the use of an intervention, (ie, not try it even once), initiate use, and go on to discontinue or continue to use an intervention. METHODS The study had 3 arms: one received access to CCBT (n=301); another received CCBT plus OHC (n=302), which included a moderated internet support group; and the third received usual care (n=101). Participants in the 2 active intervention arms of the study were grouped together for analyses of CCBT use (n=603) because both arms had access to CCBT, and there were no differences in outcomes between the 2 arms. Analyses of OHC use were based on 302 participants who were randomized to that arm. RESULTS Several baseline patient characteristics were associated with failure to initiate the use of CCBT, including having worse physical health (measured by the Short Form Health Survey Physical Components Score, P=.01), more interference from pain (by the Patient-Reported Outcomes Measurement Information System Pain Interference score, P=.048), less formal education (P=.02), and being African American or another US minority group (P=.006). Characteristics associated with failure to initiate use of the OHC were better mental health (by the Short Form Health Survey Mental Components Score, P=.04), lower use of the internet (P=.005), and less formal education (P=.001). Those who initiated the use of the CCBT program but went on to complete less of the program had less formal education (P=.01) and lower severity of anxiety symptoms (P=.03). CONCLUSIONS This study found that several patient characteristics predicted whether a patient was likely to not initiate use or discontinue the use of CCBT or OHC. These findings have clear implications for actionable areas that can be targeted during initial and ongoing engagement activities designed to increase patient buy-in, as well as increase subsequent use and the resulting success of eHealth programs. TRIAL REGISTRATION ClinicalTrials.gov NCT01482806; https://clinicaltrials.gov/study/NCT01482806.
Collapse
Affiliation(s)
- Armando J Rotondi
- Mental Illness Research Education and Clinical Center, VA Pittsburgh Healthcare System, Veterans Administration, Pittsburgh, PA, United States
- Center for Behavioral Health, Media and Technology, University of Pittsburgh, Pittsburgh, PA, United States
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Veterans Administration, Pittsburgh, PA, United States
| | - Bea Herbeck Belnap
- Center for Behavioral Health, Media and Technology, University of Pittsburgh, Pittsburgh, PA, United States
- Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Scott Rothenberger
- Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Robert Feldman
- Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Barbara Hanusa
- Mental Illness Research Education and Clinical Center, VA Pittsburgh Healthcare System, Veterans Administration, Pittsburgh, PA, United States
| | - Bruce L Rollman
- Center for Behavioral Health, Media and Technology, University of Pittsburgh, Pittsburgh, PA, United States
- Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| |
Collapse
|
24
|
Shaw G, Castro BA, Gunn LH, Norris K, Thorpe RJ. The Association of eHealth Literacy Skills and mHealth Application Use Among US Adults With Obesity: Analysis of Health Information National Trends Survey Data. JMIR Mhealth Uhealth 2024; 12:e46656. [PMID: 38198196 PMCID: PMC10809169 DOI: 10.2196/46656] [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: 02/22/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Physical inactivity and a poor diet are modifiable behaviors that contribute to obesity. Obesity is a well-recognized risk factor for chronic diseases, including diabetes. Mobile health (mHealth) apps can play an important adjuvant role in preventing and treating chronic diseases and promoting positive health behavior change among people with obesity, and eHealth literacy skills have the potential to impact mHealth app use. OBJECTIVE The purpose of this study was to explore the associations between the 2 dimensions, access and application, of eHealth literacy skills and mHealth app use among US adults (≥18 years of age) with obesity (BMI ≥30 kg/m2). METHODS Data were obtained from February to June 2020 using the Health Information National Trends Survey 5. A total of 1079 respondents met the inclusion criteria of adults with obesity and owners of smartphones. Individual associations between mHealth app use and sociodemographic variables were explored using weighted chi-square and 2-tailed t tests. A multivariable weighted logistic regression model was fitted, and adjusted odds ratios (ORs) of using mHealth apps with corresponding 95% CIs were reported across multiple sociodemographic variables. An Ising model-weighted network visualization was produced. A receiver operating characteristic curve was calculated, and the area under the curve was reported with the corresponding Delong 95% CI. RESULTS A majority of respondents were female (550/923, 59.6%) or non-Hispanic White (543/923, 58.8%). Individuals in households earning less than US $50,000 comprised 41.4% (382/923) of the sample. All sociodemographic variables were found to be univariately significant at the 5% level, except employment and region. Results from the multivariable weighted logistic regression model showed that the adjusted odds of using an mHealth app are 3.13 (95% CI 1.69-5.80) and 2.99 (95% CI 1.67-5.37) times higher among those with an access eHealth literacy skill of using an electronic device to look for health or medical information for themselves and an application eHealth literacy skill of using electronic communications with a doctor or doctor's office, respectively. Several sociodemographic variables were found to be significant, such as education, where adjusted ORs comparing subgroups to the lowest educational attainment were substantial (ORs ≥7.77). The network visualization demonstrated that all eHealth literacy skills and the mHealth app use variable were positively associated to varying degrees. CONCLUSIONS This work provides an initial understanding of mHealth app use and eHealth literacy skills among people with obesity, identifying people with obesity subpopulations who are at risk of a digital health divide. Future studies should identify equitable solutions for people with obesity (as well as other groups) and their use of mHealth apps.
Collapse
Affiliation(s)
- George Shaw
- Department of Public Health Sciences, School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Bianca A Castro
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Laura H Gunn
- Department of Public Health Sciences, School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Keith Norris
- The University of California Los Angeles Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA, United States
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, United States
| |
Collapse
|
25
|
Espinola CW, Nguyen B, Torres A, Sim W, Rueda A, Beavers L, Campbell DM, Jung H, Lou W, Kapralos B, Peter E, Dubrowski A, Krishnan S, Bhat V. Digital Interventions for Stress Among Frontline Health Care Workers: Results From a Pilot Feasibility Cohort Trial. JMIR Serious Games 2024; 12:e42813. [PMID: 38194247 PMCID: PMC10783335 DOI: 10.2196/42813] [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: 09/21/2022] [Revised: 08/03/2023] [Accepted: 09/30/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has challenged the mental health of health care workers, increasing the rates of stress, moral distress (MD), and moral injury (MI). Virtual reality (VR) is a useful tool for studying MD and MI because it can effectively elicit psychophysiological responses, is customizable, and permits the controlled study of participants in real time. OBJECTIVE This study aims to investigate the feasibility of using an intervention comprising a VR scenario and an educational video to examine MD among health care workers during the COVID-19 pandemic and to use our mobile app for longitudinal monitoring of stress, MD, and MI after the intervention. METHODS We recruited 15 participants for a compound intervention consisting of a VR scenario followed by an educational video and a repetition of the VR scenario. The scenario portrayed a morally challenging situation related to a shortage of life-saving equipment. Physiological signals and scores of the Moral Injury Outcome Scale (MIOS) and Perceived Stress Scale (PSS) were collected. Participants underwent a debriefing session to provide their impressions of the intervention, and content analysis was performed on the sessions. Participants were also instructed to use a mobile app for 8 weeks after the intervention to monitor stress, MD, and mental health symptoms. We conducted Wilcoxon signed rank tests on the PSS and MIOS scores to investigate whether the VR scenario could induce stress and MD. We also evaluated user experience and the sense of presence after the intervention through semi-open-ended feedback and the Igroup Presence Questionnaire, respectively. Qualitative feedback was summarized and categorized to offer an experiential perspective. RESULTS All participants completed the intervention. Mean pre- and postintervention scores were respectively 10.4 (SD 9.9) and 13.5 (SD 9.1) for the MIOS and 17.3 (SD 7.5) and 19.1 (SD 8.1) for the PSS. Statistical analyses revealed no significant pre- to postintervention difference in the MIOS and PSS scores (P=.11 and P=.22, respectively), suggesting that the experiment did not acutely induce significant levels of stress or MD. However, content analysis revealed feelings of guilt, shame, and betrayal, which relate to the experience of MD. On the basis of the Igroup Presence Questionnaire results, the VR scenario achieved an above-average degree of overall presence, spatial presence, and involvement, and slightly below-average realism. Of the 15 participants, 8 (53%) did not answer symptom surveys on the mobile app. CONCLUSIONS Our study demonstrated VR to be a feasible method to simulate morally challenging situations and elicit genuine responses associated with MD with high acceptability and tolerability. Future research could better define the efficacy of VR in examining stress, MD, and MI both acutely and in the longer term. An improved participant strategy for mobile data capture is needed for future studies. TRIAL REGISTRATION ClinicalTrails.gov NCT05001542; https://clinicaltrials.gov/study/NCT05001542. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/32240.
Collapse
Affiliation(s)
- Caroline W Espinola
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Binh Nguyen
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Andrei Torres
- maxSIMhealth Group, Ontario Tech University, Oshawa, ON, Canada
| | - Walter Sim
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Alice Rueda
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Lindsay Beavers
- Allan Waters Family Simulation Program, Unity Health Toronto, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Douglas M Campbell
- Allan Waters Family Simulation Program, Unity Health Toronto, Toronto, ON, Canada
- Neonatal Intensive Care Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hyejung Jung
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Bill Kapralos
- maxSIMhealth Group, Ontario Tech University, Oshawa, ON, Canada
| | - Elizabeth Peter
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Adam Dubrowski
- maxSIMhealth Group, Ontario Tech University, Oshawa, ON, Canada
| | - Sridhar Krishnan
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Venkat Bhat
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| |
Collapse
|
26
|
Moungui HC, Nana-Djeunga HC, Anyiang CF, Cano M, Ruiz Postigo JA, Carrion C. Dissemination Strategies for mHealth Apps: Systematic Review. JMIR Mhealth Uhealth 2024; 12:e50293. [PMID: 38180796 PMCID: PMC10799285 DOI: 10.2196/50293] [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: 06/26/2023] [Revised: 10/27/2023] [Accepted: 11/03/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Among the millions of mobile apps in existence, thousands fall under the category of mobile health (mHealth). Although the utility of mHealth apps has been demonstrated for disease diagnosis, treatment data management, and health promotion strategies, to be effective they must reach and be used by their target audience. An appropriate marketing strategy can ensure that apps reach potential users and potentially convert them to actual users. Such a strategy requires definitions of target end users, communication channels, and advertising content, as well as a timeline for effectively reaching and motivating end users to adopt and maintain engagement with the mHealth app. OBJECTIVE The aim of this study was to identify strategies and elements that ensure that end users adopt and remain engaged with mHealth apps. METHODS A systematic search of the PubMed, PsycINFO, Scopus, and CINAHL databases was conducted for suitable studies published between January 1, 2018, and September 30, 2022. Two researchers independently screened studies for inclusion, extracted data, and assessed the risk of bias. The main outcome was dissemination strategies for mHealth apps. RESULTS Of the 648 papers retrieved from the selected databases, only 10 (1.5%) met the inclusion criteria. The marketing strategies used in these studies to inform potential users of the existence of mHealth apps and motivate download included both paid and unpaid strategies and used various channels, including social media, emails, printed posters, and face-to-face communication. Most of the studies reported a combination of marketing concepts used to advertise their mHealth apps. Advertising messages included instructions on where and how to download and install the apps. In most of the studies (6/10, 60%), instructions were oriented toward how to use the apps and maintain engagement with a health intervention. The most frequently used paid marketing platform was Facebook Ads Manager (2/10, 20%). Advertising performance was influenced by many factors, including but not limited to advertising content. In 1 (10%) of the 10 studies, animated graphics generated the greatest number of clicks compared with other image types. The metrics used to assess marketing strategy effectiveness were number of downloads; nonuse rate; dropout rate; adherence rate; duration of app use; and app usability over days, weeks, or months. Additional indicators such as cost per click, cost per install, and clickthrough rate were mainly used to assess the cost-effectiveness of paid marketing campaigns. CONCLUSIONS mHealth apps can be disseminated via paid and unpaid marketing strategies using various communication channels. The effects of these strategies are reflected in download numbers and user engagement with mHealth apps. Further research could provide guidance on a framework for disseminating mHealth apps and encouraging their routine use.
Collapse
Affiliation(s)
| | | | | | - Mireia Cano
- eHealth Lab Research Group, eHealth Center & School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Jose Antonio Ruiz Postigo
- Prevention, Treatment and Care Unit, Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Carme Carrion
- eHealth Lab Research Group, eHealth Center & School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| |
Collapse
|
27
|
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.
Collapse
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.
| |
Collapse
|
28
|
Sedotto RNM, Edwards AE, Dulin PL, King DK. Engagement with mHealth Alcohol Interventions: User Perspectives on an App or Chatbot-Delivered Program to Reduce Drinking. Healthcare (Basel) 2024; 12:101. [PMID: 38201007 PMCID: PMC10778607 DOI: 10.3390/healthcare12010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Research suggests participant engagement is a key mediator of mHealth alcohol interventions' effectiveness in reducing alcohol consumption among users. Understanding the features that promote engagement is critical to maximizing the effectiveness of mHealth-delivered alcohol interventions. The purpose of this study was to identify facilitators and barriers to mHealth alcohol intervention utilization among hazardous-drinking participants who were randomized to use either an app (Step Away) or Artificial Intelligence (AI) chatbot-based intervention for reducing drinking (the Step Away chatbot). We conducted semi-structured interviews from December 2019 to January 2020 with 20 participants who used the app or chatbot for three months, identifying common facilitators and barriers to use. Participants of both interventions reported that tracking their drinking, receiving feedback about their drinking, feeling held accountable, notifications about high-risk drinking times, and reminders to track their drinking promoted continued engagement. Positivity, personalization, gaining insight into their drinking, and daily tips were stronger facilitator themes among bot users, indicating these may be strengths of the AI chatbot-based intervention when compared to a user-directed app. While tracking drinking was a theme among both groups, it was more salient among app users, potentially due to the option to quickly track drinks in the app that was not present with the conversational chatbot. Notification glitches, technology glitches, and difficulty with tracking drinking data were usage barriers for both groups. Lengthy setup processes were a stronger barrier for app users. Repetitiveness of the bot conversation, receipt of non-tailored daily tips, and inability to self-navigate to desired content were reported as barriers by bot users. To maximize engagement with AI interventions, future developers should include tracking to reinforce behavior change self-monitoring and be mindful of repetitive conversations, lengthy setup, and pathways that limit self-directed navigation.
Collapse
Affiliation(s)
- Robyn N. M. Sedotto
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, AK 99508, USA; (A.E.E.); (D.K.K.)
| | - Alexandra E. Edwards
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, AK 99508, USA; (A.E.E.); (D.K.K.)
| | - Patrick L. Dulin
- Department of Psychology, University of Alaska Anchorage, Anchorage, AK 99508, USA;
| | - Diane K. King
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, AK 99508, USA; (A.E.E.); (D.K.K.)
| |
Collapse
|
29
|
Oh J, Capezzuto L, Kriara L, Schjodt-Eriksen J, van Beek J, Bernasconi C, Montalban X, Butzkueven H, Kappos L, Giovannoni G, Bove R, Julian L, Baker M, Gossens C, Lindemann M. Use of smartphone-based remote assessments of multiple sclerosis in Floodlight Open, a global, prospective, open-access study. Sci Rep 2024; 14:122. [PMID: 38168498 PMCID: PMC10762023 DOI: 10.1038/s41598-023-49299-4] [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: 11/04/2022] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Floodlight Open was a global, open-access, digital-only study designed to understand the drivers and barriers in deployment and use of a smartphone app in a naturalistic setting and broad study population of people with and without multiple sclerosis (MS). The study utilised the Floodlight Open app: a 'bring-your-own-device' solution that remotely measures a user's mood, cognition, hand motor function, and gait and postural stability via smartphone sensor-based tests requiring active user input ('active tests'). Levels of mobility of study participants ('life-space measurement') were passively measured. Study data from these tests were made available via an open-access platform. Data from 1350 participants with self-declared MS and 1133 participants with self-declared non-MS from 17 countries across four continents were included in this report. Overall, MS participants provided active test data for a mean duration of 5.6 weeks or a mean duration of 19 non-consecutive days. This duration increased among MS participants who persisted beyond the first week to a mean of 10.3 weeks or 36.5 non-consecutive days. Passively collected life-space measurement data were generated by MS participants for a mean duration of 9.8 weeks or 50.6 non-consecutive days. This duration increased to 16.3 weeks/85.1 non-consecutive days among MS participants who persisted beyond the first week. Older age, self-declared MS disease status, and clinical supervision as part of concomitant clinical research were all significantly associated with higher persistence of the use of the Floodlight Open app. MS participants performed significantly worse than non-MS participants on four out of seven active tests. The findings from this multinational study inform future research to improve the dynamics of persistence of use of digital monitoring tools and further highlight challenges and opportunities in applying them to support MS clinical care.
Collapse
Affiliation(s)
- Jiwon Oh
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Lito Kriara
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | - Johan van Beek
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
- Biogen Digital Health International GmbH, Baar, Switzerland
| | - Corrado Bernasconi
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
- Limites Medical Research Ltd., Vacallo, Switzerland
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Ludwig Kappos
- Research Center Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Riley Bove
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Mike Baker
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | | |
Collapse
|
30
|
Liu H, Xie Z, Or C. Willingness to pay for health apps, its sociodemographic correlates, and reasons for being unwilling to pay. Digit Health 2024; 10:20552076241248925. [PMID: 38698831 PMCID: PMC11064745 DOI: 10.1177/20552076241248925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Background Knowledge about whether, how much, and why individuals are willing to pay for health apps is limited. Objectives This study aimed to examine (1) the proportion of individuals willing to pay for health apps, (2) their willingness to pay (WTP; i.e. the maximum price the individual is willing to pay) for health apps, (3) the sociodemographic correlates determining whether individuals are willing to pay for these apps, (4) the sociodemographic correlates of their WTP, and (5) reasons for being unwilling to pay. Methods Six hundred adults were invited to participate in a questionnaire survey examining their sociodemographic characteristics, WTP for health apps, and reasons for being unwilling to pay. Sociodemographic characteristics and WTP for health apps were analyzed using descriptive statistics. Logistic regression was applied to examine the sociodemographic variables correlated with whether individuals were willing to pay for health apps. Among those who were willing to pay, log-linear regression was conducted to examine the sociodemographic correlates of their WTP. The reasons for unwillingness to pay were descriptively analyzed. Results A total of 577 individuals completed the questionnaire. Of them, 58.9% were willing to pay for health apps. Their median WTP was HK$50 (HK$1 ≈ US$0.13). Participants with a bachelor's degree or higher and those who had previously installed health apps were more inclined to pay for health apps. WTP was positively associated with the maximum price previously paid for a health app. The most frequently cited reasons for being unwilling to pay were the belief that the government should provide free health apps, distrust in health apps, and a lack of awareness of health apps and their benefits. Conclusions This study provides insights that can inform strategies to enhance the marketability, affordability, and accessibility of health apps.
Collapse
Affiliation(s)
- Hao Liu
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Zhenzhen Xie
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Calvin Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
31
|
Park SY, Yourell J, McAlister KL, Huberty J. Exploring Generation Z and Young Millennials' Perspectives of a Spiritual Self-Care App and Their Spiritual Identity (Skylight): Qualitative Semistructured Interview Study. JMIR Form Res 2023; 7:e54284. [PMID: 38064199 PMCID: PMC10784987 DOI: 10.2196/54284] [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: 11/03/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Generation Z and young millennials (ages 18-35 years), collectively referred to as GenZennials, are connected to technology and the internet like no other generation before them. This has mental health implications, such as increased rates of anxiety and stress. Recent research has shown that app-based mental health interventions can be useful to address such mental health concerns. However, spirituality is an untapped resource, especially since GenZennials largely identify as spiritual and already integrate spiritual practices into their self-care. OBJECTIVE There were four objectives to this study: (1) comprehensively explore reasons why GenZennials use a spiritual self-care app (ie, Skylight; Radiant Foundation), (2) understand how GenZennials identify spiritually, (3) understand the app's relevance to GenZennials, and (4) gather feedback and suggestions to improve the app. METHODS Semistructured interviews were conducted with 23 GenZennials (ages 18-35 years; mean 28.7, SD 5.0 years; n=20, 87% female) who used the Skylight app. Interviews were 30 to 60 minutes and conducted on Zoom. Thematic analysis was used to analyze interviews. RESULTS Five major categories emerged from the analysis, each encompassing one to several themes: (1) reasons for using the Skylight app, (2) content favorites, (3) defining spiritual identity, (4) relevance to GenZennials, and (5) overall improvement recommendations. Participants used the app for various reasons including to relax, escape, or ground themselves; improve mood; and enhance overall health and wellness. Participants also cited the app's variety of content offerings and its free accessibility as their primary reasons for using it. Most participants identified themselves as solely spiritual (8/23/35%) among the options provided (ie, spiritual or religious or both), and they appreciated the app's inclusive content. Participants felt that the app was relevant to their generation as it offered modern content (eg, spiritual self-care activities and short content). Participants recommended adding more personalization capabilities, content, and representation to the app. CONCLUSIONS This is the first study to qualitatively explore GenZennials' perspectives and the use of a spiritual self-care app. Our findings should inform the future creation and improvement of spiritual self-care apps aimed at cultivating GenZennials' spiritual and mental well-being. Future research is warranted to examine the effects of using a spiritual self-care app on GenZennial mental health.
Collapse
Affiliation(s)
- Susanna Y Park
- Skylight, Radiant Foundation, Salt Lake City, UT, United States
| | | | | | | |
Collapse
|
32
|
Ng MY, Olgin JE, Marcus GM, Lyles CR, Pletcher MJ. Email-Based Recruitment Into the Health eHeart Study: Cohort Analysis of Invited Eligible Patients. J Med Internet Res 2023; 25:e51238. [PMID: 38133910 PMCID: PMC10770794 DOI: 10.2196/51238] [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: 08/09/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Web- or app-based digital health studies allow for more efficient collection of health data for research. However, remote recruitment into digital health studies can enroll nonrepresentative study samples, hindering the robustness and generalizability of findings. Through the comprehensive evaluation of an email-based campaign on recruitment into the Health eHeart Study, we aim to uncover key sociodemographic and clinical factors that contribute to enrollment. OBJECTIVE This study sought to understand the factors related to participation, specifically regarding enrollment, in the Health eHeart Study as a result of a large-scale remote email recruitment campaign. METHODS We conducted a cohort analysis on all invited University of California, San Francisco (UCSF) patients to identify sociodemographic and clinical predictors of enrollment into the Health eHeart Study. The primary outcome was enrollment, defined by account registration and consent into the Health eHeart Study. The email recruitment campaign was carried out from August 2015 to February 2016, with electronic health record data extracted between September 2019 and December 2019. RESULTS The email recruitment campaign delivered at least 1 email invitation to 93.5% (193,606/206,983) of all invited patients and yielded a 3.6% (7012/193,606) registration rate among contacted patients and an 84.1% (5899/7012) consent rate among registered patients. Adjusted multivariate logistic regression models analyzed independent sociodemographic and clinical predictors of (1) registration among contacted participants and (2) consent among registered participants. Odds of registration were higher among patients who are older, women, non-Hispanic White, active patients with commercial insurance or Medicare, with a higher comorbidity burden, with congestive heart failure, and randomized to receive up to 2 recruitment emails. The odds of registration were lower among those with medical conditions such as dementia, chronic pulmonary disease, moderate or severe liver disease, paraplegia or hemiplegia, renal disease, or cancer. Odds of subsequent consent after initial registration were different, with an inverse trend of being lower among patients who are older and women. The odds of consent were also lower among those with peripheral vascular disease. However, the odds of consent remained higher among patients who were non-Hispanic White and those with commercial insurance. CONCLUSIONS This study provides important insights into the potential returns on participant enrollment when digital health study teams invest resources in using email for recruitment. The findings show that participant enrollment was driven more strongly by sociodemographic factors than clinical factors. Overall, email is an extremely efficient means of recruiting participants from a large list into the Health eHeart Study. Despite some improvements in representation, the formulation of truly diverse studies will require additional resources and strategies to overcome persistent participation barriers.
Collapse
Affiliation(s)
- Madelena Y Ng
- School of Public Health, University of California, Berkeley, CA, United States
- Department of Medicine (Biomedical Informatics), Stanford University, Stanford, CA, United States
- Department of Medicine, University of California, San Francisco, CA, United States
| | - Jeffrey E Olgin
- Department of Medicine, University of California, San Francisco, CA, United States
| | - Gregory M Marcus
- Department of Medicine, University of California, San Francisco, CA, United States
| | - Courtney R Lyles
- School of Public Health, University of California, Berkeley, CA, United States
- Department of Medicine, University of California, San Francisco, CA, United States
- Department of Public Health Sciences, University of California, Davis, CA, United States
| | - Mark J Pletcher
- Department of Medicine, University of California, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
| |
Collapse
|
33
|
Berry M, Taylor L, Huang Z, Chwyl C, Kerrigan S, Forman E. Automated Messaging Delivered Alongside Behavioral Treatment for Weight Loss: Qualitative Study. JMIR Form Res 2023; 7:e50872. [PMID: 37930786 PMCID: PMC10660236 DOI: 10.2196/50872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Mobile health interventions for weight loss frequently use automated messaging. However, this intervention modality appears to have limited weight loss efficacy. Furthermore, data on users' subjective experiences while receiving automated messaging-based interventions for weight loss are scarce, especially for more advanced messaging systems providing users with individually tailored, data-informed feedback. OBJECTIVE The purpose of this study was to characterize the experiences of individuals with overweight or obesity who received automated messages for 6-12 months as part of a behavioral weight loss trial. METHODS Participants (n=40) provided Likert-scale ratings of messaging acceptability and completed a structured qualitative interview (n=39) focused on their experiences with the messaging system and generating suggestions for improvement. Interview data were analyzed using thematic analysis. RESULTS Participants found the messages most useful for summarizing goal progress and least useful for suggesting new behavioral strategies. Overall message acceptability was moderate (2.67 out of 5). From the interviews, 2 meta-themes emerged. Participants indicated that although the messages provided useful reminders of intervention goals and skills, they did not adequately capture their lived experiences while losing weight. CONCLUSIONS Many participants found the automated messages insufficiently tailored to their personal weight loss experiences. Future studies should explore alternative methods for message tailoring (eg, allowing for a higher degree of participant input and interactivity) that may boost treatment engagement and efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT05231824; https://clinicaltrials.gov/study/NCT05231824.
Collapse
Affiliation(s)
- Michael Berry
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Lauren Taylor
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA, United States
| | - Zhuoran Huang
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA, United States
| | - Christina Chwyl
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA, United States
| | | | - Evan Forman
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA, United States
| |
Collapse
|
34
|
Jibb LA, Sivaratnam S, Hashemi E, Chu CH, Nathan PC, Chartrand J, Alberts NM, Masama T, Pease HG, Torres LB, Cortes HG, Zworth M, Kuczynski S, Fortier MA. Parent and clinician perceptions and recommendations on a pediatric cancer pain management app: A qualitative co-design study. PLOS DIGITAL HEALTH 2023; 2:e0000169. [PMID: 38019890 PMCID: PMC10686487 DOI: 10.1371/journal.pdig.0000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 10/14/2023] [Indexed: 12/01/2023]
Abstract
Pain is one of the most prevalent and burdensome pediatric cancer symptoms for young children and their families. A significant proportion of pain episodes are experienced in environments where management options are limited, including at home. Digital innovations such as apps may have positive impacts on pain outcomes for young children in these environments. Our overall aim is to co-design such an app and the objective of this study was to explore the perceptions of children's parents about app utility, needed system features, and challenges. We recruited parents of young children with cancer and multidisciplinary pediatric oncology clinicians from two pediatric cancer care centers to participate in audio-recorded, semi-structured, co-design interviews. We conducted interviews structured around technology acceptance and family caregiving theories until data saturation was reached. Audio-recordings were then transcribed, coded, and analyzed using thematic analysis. Forty-two participants took part in the process. Participants endorsed the concept of an app as a useful, safe, and convenient way to engage caregivers in managing their young child's pain. Overall, the app was valued as a means to provide real-time, multimodal informational and procedural pain support to parents, while also reducing the emotional burden of pain care. Recommendations for intervention design included accessibility-focused features, comprehensive symptom tracking, and embedded scientific- and clinically-sound symptom assessments and management advice. Predicted challenges to app use included the workload burden it may place on parents and clinicians. The insights gathered will inform the design principles of our future childhood cancer pain digital research.
Collapse
Affiliation(s)
- Lindsay A. Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
| | - Surabhi Sivaratnam
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Elham Hashemi
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
| | - Charlene H. Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Paul C. Nathan
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Julie Chartrand
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Tatenda Masama
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Hannah G. Pease
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
| | - Lessley B. Torres
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
- Department of Pediatric Psychology, Children’s Hospital of Orange County, Orange, California, United States of America
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, United States of America
| | - Haydee G. Cortes
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
- Department of Pediatric Psychology, Children’s Hospital of Orange County, Orange, California, United States of America
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, United States of America
| | - Mallory Zworth
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer, Toronto, Canada
| | - Michelle A. Fortier
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
- Department of Pediatric Psychology, Children’s Hospital of Orange County, Orange, California, United States of America
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, United States of America
| |
Collapse
|
35
|
Moulaei K, Bahaadinbeigy K, Mashoof E, Dinari F. Design and development of a mobile-based self-care application for patients with depression and anxiety disorders. BMC Med Inform Decis Mak 2023; 23:199. [PMID: 37784042 PMCID: PMC10544565 DOI: 10.1186/s12911-023-02308-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] [Received: 08/19/2022] [Accepted: 09/26/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND AND AIM Depression and anxiety can cause social, behavioral, occupational, and functional impairments if not controlled and managed. Mobile-based self-care applications can play an essential and effective role in controlling and reducing the effects of anxiety disorders and depression. The aim of this study was to design and develop a mobile-based self-care application for patients with depression and anxiety disorders with the goal of enhancing their mental health and overall well-being. MATERIALS AND METHODS In this study we designed a mobile-based application for self -management of depression and anxiety disorders. In order to design this application, first the education- informational needs and capabilities were identified through a systematic review. Then, according to 20 patients with depression and anxiety, this education-informational needs and application capabilities were approved. In the next step, the application was designed. RESULTS In the first step, 80 education-information needs and capabilities were identified. Finally, in the second step, of 80 education- informational needs and capabilities, 68 needs and capabilities with a mean greater than and equal to 3.75 (75%) were considered in application design. Disease control and management, drug management, nutrition and diet management, recording clinical records, communicating with physicians and other patients, reminding appointments, how to improve lifestyle, quitting smoking and reducing alcohol consumption, educational content, sedation instructions, introducing health care centers for depression and anxiety treatment and recording activities, personal goals and habits in a diary were the most important features of this application. CONCLUSION The designed application can encourage patients with depression and stress to perform self-care processes and access necessary information without searching the Internet.
Collapse
Affiliation(s)
- Khadijeh Moulaei
- Department of Health Information Technology, Faculty of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmat Mashoof
- Department of Health Information Technology, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | - Fatemeh Dinari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| |
Collapse
|
36
|
Javed A, Kim DS, Hershman SG, Shcherbina A, Johnson A, Tolas A, O’Sullivan JW, McConnell MV, Lazzeroni L, King AC, Christle JW, Oppezzo M, Mattsson CM, Harrington RA, Wheeler MT, Ashley EA. Personalized digital behaviour interventions increase short-term physical activity: a randomized control crossover trial substudy of the MyHeart Counts Cardiovascular Health Study. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:411-419. [PMID: 37794870 PMCID: PMC10545510 DOI: 10.1093/ehjdh/ztad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/27/2023] [Indexed: 10/06/2023]
Abstract
Aims Physical activity is associated with decreased incidence of the chronic diseases associated with aging. We previously demonstrated that digital interventions delivered through a smartphone app can increase short-term physical activity. Methods and results We offered enrolment to community-living iPhone-using adults aged ≥18 years in the USA, UK, and Hong Kong who downloaded the MyHeart Counts app. After completion of a 1-week baseline period, e-consented participants were randomized to four 7-day interventions. Interventions consisted of: (i) daily personalized e-coaching based on the individual's baseline activity patterns, (ii) daily prompts to complete 10 000 steps, (iii) hourly prompts to stand following inactivity, and (iv) daily instructions to read guidelines from the American Heart Association (AHA) website. After completion of one 7-day intervention, participants subsequently randomized to the next intervention of the crossover trial. The trial was completed in a free-living setting, where neither the participants nor investigators were blinded to the intervention. The primary outcome was change in mean daily step count from baseline for each of the four interventions, assessed in a modified intention-to-treat analysis (modified in that participants had to complete 7 days of baseline monitoring and at least 1 day of an intervention to be included in analyses). This trial is registered with ClinicalTrials.gov, NCT03090321. Conclusion Between 1 January 2017 and 1 April 2022, 4500 participants consented to enrol in the trial (a subset of the approximately 50 000 participants in the larger MyHeart Counts study), of whom 2458 completed 7 days of baseline monitoring (mean daily steps 4232 ± 73) and at least 1 day of one of the four interventions. Personalized e-coaching prompts, tailored to an individual based on their baseline activity, increased step count significantly (+402 ± 71 steps from baseline, P = 7.1⨯10-8). Hourly stand prompts (+292 steps from baseline, P = 0.00029) and a daily prompt to read AHA guidelines (+215 steps from baseline, P = 0.021) were significantly associated with increased mean daily step count, while a daily reminder to complete 10 000 steps was not (+170 steps from baseline, P = 0.11). Digital studies have a significant advantage over traditional clinical trials in that they can continuously recruit participants in a cost-effective manner, allowing for new insights provided by increased statistical power and refinement of prior signals. Here, we present a novel finding that digital interventions tailored to an individual are effective in increasing short-term physical activity in a free-living cohort. These data suggest that participants are more likely to react positively and increase their physical activity when prompts are personalized. Further studies are needed to determine the effects of digital interventions on long-term outcomes.
Collapse
Affiliation(s)
- Ali Javed
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Daniel Seung Kim
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Steven G Hershman
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Biofourmis, Boston, MA, USA
| | - Anna Shcherbina
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Anders Johnson
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Alexander Tolas
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jack W O’Sullivan
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael V McConnell
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- identifeye HEALTH, Redwood City, CA, USA
| | - Laura Lazzeroni
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Abby C King
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Health Research and Policy, Stanford University, Stanford, CA, USA
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeffrey W Christle
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Marily Oppezzo
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - C Mikael Mattsson
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Robert A Harrington
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Matthew T Wheeler
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA
| | - Euan A Ashley
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| |
Collapse
|
37
|
Renner B, Buyken AE, Gedrich K, Lorkowski S, Watzl B, Linseisen J, Daniel H. Perspective: A Conceptual Framework for Adaptive Personalized Nutrition Advice Systems (APNASs). Adv Nutr 2023; 14:983-994. [PMID: 37419418 PMCID: PMC10509404 DOI: 10.1016/j.advnut.2023.06.009] [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: 10/01/2022] [Revised: 05/06/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023] Open
Abstract
Nearly all approaches to personalized nutrition (PN) use information such as the gene variants of individuals to deliver advice that is more beneficial than a generic "1-size-fits-all" recommendation. Despite great enthusiasm and the increased availability of commercial services, thus far, scientific studies have only revealed small to negligible effects on the efficacy and effectiveness of personalized dietary recommendations, even when using genetic or other individual information. In addition, from a public health perspective, scholars are critical of PN because it primarily targets socially privileged groups rather than the general population, thereby potentially widening health inequality. Therefore, in this perspective, we propose to extend current PN approaches by creating adaptive personalized nutrition advice systems (APNASs) that are tailored to the type and timing of personalized advice for individual needs, capacities, and receptivity in real-life food environments. These systems encompass a broadening of current PN goals (i.e., what should be achieved) to incorporate "individual goal preferences" beyond currently advocated biomedical targets (e.g., making sustainable food choices). Moreover, they cover the "personalization processes of behavior change" by providing in situ, "just-in-time" information in real-life environments (how and when to change), which accounts for individual capacities and constraints (e.g., economic resources). Finally, they are concerned with a "participatory dialog between individuals and experts" (e.g., actual or virtual dieticians, nutritionists, and advisors) when setting goals and deriving measures of adaption. Within this framework, emerging digital nutrition ecosystems enable continuous, real-time monitoring, advice, and support in food environments from exposure to consumption. We present this vision of a novel PN framework along with scenarios and arguments that describe its potential to efficiently address individual and population needs and target groups that would benefit most from its implementation.
Collapse
Affiliation(s)
- Britta Renner
- Department of Psychology and Centre for the Advanced Study of Collective Behavior, Psychological Assessment and Health Psychology, University of Konstanz, Konstanz, Germany.
| | - Anette E Buyken
- Public Health Nutrition, Paderborn University, Paderborn, Germany
| | - Kurt Gedrich
- ZIEL-Institute for Food and Health, Technical University of Munich, Freising, Germany
| | - Stefan Lorkowski
- Institute of Nutritional Sciences Friedrich Schiller University Jena, Jena, Germany, and Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Germany
| | - Bernhard Watzl
- Ex. Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
| | - Jakob Linseisen
- University Hospital Augsburg, University of Augsburg, Augsburg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Hannelore Daniel
- Ex. School of Life Sciences, Technical University of Munich, Freising, Germany
| |
Collapse
|
38
|
Sehrawat O, Noseworthy PA, Siontis KC, Haddad TC, Halamka JD, Liu H. Data-Driven and Technology-Enabled Trial Innovations Toward Decentralization of Clinical Trials: Opportunities and Considerations. Mayo Clin Proc 2023; 98:1404-1421. [PMID: 37661149 DOI: 10.1016/j.mayocp.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/25/2023] [Accepted: 02/08/2023] [Indexed: 09/05/2023]
Abstract
Traditional trial designs have well-recognized inefficiencies and logistical barriers to participation. Decentralized trials and digital health solutions have been suggested as potential solutions and have certainly risen to the challenge during the pandemic. Clinical trial designs are now increasingly data driven. The use of distributed clinical data networks and digitization has helped to fundamentally upgrade existing research systems. A trial design may vary anywhere from fully decentralized to hybrid to traditional on-site. Various decentralization components are available for stakeholders to increase the reach and pace of their trials, such as electronic informed consent, remote interviews, administration, outcome assessment, monitoring, and laboratory and imaging modalities. Furthermore, digital health technologies can be included to enrich study conduct. However, careful consideration is warranted, including assessing verification and validity through usability studies and having various contingencies in place through dedicated risk assessment. Selecting the right combination depends not just on the ability to handle patient care and the medical know-how but also on the availability of appropriate technologic infrastructure, skills, and human resources. Throughout this process, quality of evidence generation and physician-patient relation must not be undermined. Here we also address some knowledge gaps, cost considerations, and potential impact of decentralization and digitization on inclusivity, recruitment, engagement, and retention. Last, we mention some future directions that may help drive the necessary change in the right direction.
Collapse
Affiliation(s)
- Ojasav Sehrawat
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | | | | | | | - John D Halamka
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | - Hongfang Liu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN.
| |
Collapse
|
39
|
Ghozali MT, Satibi S, Forthwengel G. The impact of mobile health applications on the outcomes of patients with chronic kidney disease: a systematic review and meta-analysis. J Med Life 2023; 16:1299-1309. [PMID: 38107714 PMCID: PMC10719786 DOI: 10.25122/jml-2023-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/11/2023] [Indexed: 12/19/2023] Open
Abstract
Chronic kidney disease is one of the main causes of mortality worldwide. It affects more than 800 million patients globally, accounting for approximately 10% of the general population. The significant burden of the disease prompts healthcare systems to implement adequate preventive and therapeutic measures. This systematic review and meta-analysis aimed to provide a concise summary of the findings published in the existing body of research about the influence that mobile health technology has on the outcomes of patients with the disease. A comprehensive systematic literature review was conducted from inception until March 1st, 2023. This systematic review and meta-analysis included all clinical trials that compared the efficacy of mobile app-based educational programs to that of more conventional educational treatment for the patients. Eleven papers were included in the current analysis, representing 759 CKD patients. 381 patients were randomly assigned to use the mobile apps, while 378 individuals were assigned to the control group. The mean systolic blood pressure was considerably lower in the mobile app group (MD -4.86; 95%-9.60, -0.13; p=0.04). Meanwhile, the mean level of satisfaction among patients who used the mobile app was considerably greater (MD 0.75; 95% CI 0.03, 1.46; p=0.04). Additionally, the mean self-management scores in the mobile app groups were significantly higher (SMD 0.534; 95% CI 0.201, 0.867; p=0.002). Mobile health applications are potentially valuable interventions for patients. This technology improved the self-management of the disease, reducing the mean levels of systolic blood pressure with a high degree of patient satisfaction.
Collapse
Affiliation(s)
- Muhammad Thesa Ghozali
- Department of Pharmaceutical Management, School of Pharmacy, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Satibi Satibi
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Gerhard Forthwengel
- Fakultat III, Hochschule Hannover, University of Applied Sciences and Arts, Hannover, Germany
| |
Collapse
|
40
|
Persson DR, Zhukouskaya K, Wegener AMK, Jørgensen LK, Bardram JE, Bækgaard P. Exploring Patient Needs and Designing Concepts for Digitally Supported Health Solutions in Managing Type 2 Diabetes: Cocreation Study. JMIR Form Res 2023; 7:e49738. [PMID: 37624633 PMCID: PMC10492168 DOI: 10.2196/49738] [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: 06/08/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Self-management of the progressive disease type 2 diabetes mellitus (T2DM) becomes part of the daily life of patients starting from the time of diagnosis. However, despite the availability of technical innovations, the uptake of digital solutions remains low. One reason that has been reported is that digital solutions often focus purely on clinical factors that may not align with the patient's perspective. OBJECTIVE The aim of this study was to develop digital solutions that address the needs of patients with T2DM, designed from the user's perspective. The goal was to address the patients' expressed real-world needs by having the users themselves choose the scope and format of the solutions. METHODS Using participatory methods, we conducted 3 cocreation workshops in collaboration with the Danish Diabetes Association, with 20 persons with T2DM and 11 stakeholders across workshops: user experience designers, researchers, and diabetes experts including a diabetes nurse. The overall structure of the 3 workshops was aligned with the 4 phases of the double diamond: initially discovering and mapping out key experienced issues, followed by a workshop on thematic mapping and definition of key concepts, and succeeded by an exploration and development of 2 prototypes. Subsequently, high-fidelity interactive prototypes were refined as part of the delivery phase, in which 7 formative usability tests were conducted. RESULTS The workshops mapped experiential topics over time from prediagnosis to the current state, resulting in a detailed exploration and understanding of 6 themes related to and based on the experiences of patients with T2DM: diabetes care, diabetes knowledge, glucose monitoring, diet, physical activity, and social aspects of diabetes. Two prototypes were developed by the participants to address some of their expressed needs over time related to the 6 themes: an activity-based continuous glucose monitoring app and a web-based guide to diabetes. Both prototypes emphasize periods of structured self-measurements of blood glucose to support evolving needs for self-exploration through distinct phases of learning, active use, and supporting use. Periods of low or intermittent use may thus not reflect a failure of design in a traditional sense but rather be a sign of evolving needs over time. CONCLUSIONS Our results indicate that the needs of patients with T2DM differ between individuals and change over time. As a result, the suggested digitally supported empowering health prototypes can be personalized to support self-exploration, individual preference in long-term management, and changing needs over time. Despite individuals experiencing different journeys with diabetes, users perceive the self-measurement of blood glucose as a universally useful tool to empower everyday decision-making.
Collapse
Affiliation(s)
- Dan Roland Persson
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Katiarina Zhukouskaya
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | | | | | - Jakob Eyvind Bardram
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Per Bækgaard
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| |
Collapse
|
41
|
Vial S, Boudhraâ S, Dumont M, Tremblay M, Riendeau S. Developing A Mobile App With a Human-Centered Design Lens to Improve Access to Mental Health Care (Mentallys Project): Protocol for an Initial Co-Design Process. JMIR Res Protoc 2023; 12:e47220. [PMID: 37606978 PMCID: PMC10481222 DOI: 10.2196/47220] [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: 03/12/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Co-design is one of the human-centered design approaches that allows end users to significantly and positively impact the design of mental health technologies. It is a promising approach to foster user acceptance and engagement in digital mental health solutions. Surprisingly, there is a lack of understanding of what co-design is in this field. In this paper, co-design is approached as a cocreation process involving persons with a lived experience of mental health problems, health professionals, and design experts who lead and facilitate the overall creative process. OBJECTIVE This paper describes an initial co-design research protocol for the development of a mobile app that aims to improve access to mental health care. It highlights the characteristics of a co-design approach in e-mental health rooted in human-centered design and led by design experts alongside health experts. The paper focuses on the first steps (phase 1) of the co-design process of the ongoing Mentallys project. METHODS This Mentallys project will be located in Montréal (Quebec, Canada). The method approach will be based on the "method stories," depicting the "making of" this project and reflecting adjustments needed to the protocol throughout the project in specific situations. Phase 1 of the process will focus on the desirability of the app. Targeted participants will include people with a lived experience of mental health problems, peer support workers and clinicians, and 3 facilitators (all design experts or researchers). Web-based sessions will be organized because of the COVID-19 pandemic, using Miro (RealtimeBoard Inc) and Zoom (Zoom Video Communications, Inc). Data collection will be based on the comments, thoughts, and new ideas of participants around the imaginary prototypes. Thematic analysis will be carried out after each session to inform a new version of the prototype. RESULTS We conducted 2 stages in phase 1 of the process. During stage 1, we explored ideas through group co-design workshops (divergent thinking). Six co-design workshops were held: 2 with only clinicians (n=7), 2 with peer support workers (n=5) and people with a lived experience of mental health problems (n=2), and 2 with all of them (n=14). A total of 6 facilitators participated in conducting activities in subgroups. During stage 2, ideas were refined through 10 dyad co-design sessions (convergent thinking). Stage 2 involved 3 participants (n=3) and 1 facilitator. Thematic analysis was performed after stage 1, while analytic questioning is being performed for stage 2. Both stages allowed several iterations of the prototypes. CONCLUSIONS The design of the co-design process, the leadership of the design expertise throughout the process, and the different forms of co-design activities are key elements in this project. We highly recommend that health researchers partner with professional designers or design researchers who are familiar with co-design. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47220.
Collapse
Affiliation(s)
- Stéphane Vial
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, École de Design, Université du Québec à Montréal, Montréal, QC, Canada
| | - Sana Boudhraâ
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, École de Design, Université du Québec à Montréal, Montréal, QC, Canada
| | - Mathieu Dumont
- Département d'ergothérapie, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | | |
Collapse
|
42
|
White JS, Salem MK, Toussaert S, Westmaas JL, Raiff BR, Crane D, Warrender E, Lyles C, Abroms L, Thrul J. Developing a Game (Inner Dragon) Within a Leading Smartphone App for Smoking Cessation: Design and Feasibility Evaluation Study. JMIR Serious Games 2023; 11:e46602. [PMID: 37566442 PMCID: PMC10457699 DOI: 10.2196/46602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/08/2023] [Accepted: 07/08/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Several stand-alone smartphone apps have used serious games to provide an engaging approach to quitting smoking. So far, the uptake of these games has been modest, and the evidence base for their efficacy in promoting smoking cessation is still evolving. The feasibility of integrating a game into a popular smoking cessation app is unclear. OBJECTIVE The aim of this paper was to describe the design and iterative development of the Inner Dragon game within Smoke Free, a smartphone app with proven efficacy, and the results of a single-arm feasibility trial as part of a broad program that seeks to assess the effectiveness of the gamified app for smoking cessation. METHODS In phase 1, the study team undertook a multistep process to design and develop the game, including web-based focus group discussions with end users (n=15). In phase 2, a single-arm study of Smoke Free users who were trying to quit (n=30) was conducted to assess the feasibility and acceptability of the integrated game and to establish the feasibility of the planned procedures for a randomized pilot trial. RESULTS Phase 1 led to the final design of Inner Dragon, informed by principles from psychology and behavioral economics and incorporating several game mechanics designed to increase user engagement and retention. Inner Dragon users maintain an evolving pet dragon that serves as a virtual avatar for the users' progress in quitting. The phase-2 study established the feasibility of the study methods. The mean number of app sessions completed per user was 13.8 (SD 13.1; median 8; range 1-46), with a mean duration per session of 5.8 (median 1.1; range 0-81.1) minutes. Overall, three-fourths (18/24, 75%) of the participants entered the Inner Dragon game at least once and had a mean of 2.4 (SD 2.4) sessions of game use. The use of Inner Dragon was positively associated with the total number of app sessions (correlation 0.57). The mean satisfaction score of participants who provided ratings (11/24, 46%) was 4.2 (SD 0.6) on a 5-point scale; however, satisfaction ratings for Inner Dragon were only completed by 13% (3/24) of the participants. CONCLUSIONS Findings supported further development and evaluation of Inner Dragon as a beneficial feature of Smoke Free. The next step of this study is to conduct a randomized pilot trial to determine whether the gamified version of the app increases user engagement over a standard version of the app.
Collapse
Affiliation(s)
- Justin S White
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, United States
| | - Marie K Salem
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States
| | | | - J Lee Westmaas
- Population Science, American Cancer Society, Atlanta, GA, United States
| | - Bethany R Raiff
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | | | | | - Courtney Lyles
- Department of Medicine, University of California, San Francisco, CA, United States
| | - Lorien Abroms
- Department of Prevention and Community Health, George Washington University, Washington, DC, United States
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, United States
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| |
Collapse
|
43
|
Trella AL, Zhang KW, Nahum-Shani I, Shetty V, Doshi-Velez F, Murphy SA. Reward Design For An Online Reinforcement Learning Algorithm Supporting Oral Self-Care. PROCEEDINGS OF THE ... INNOVATIVE APPLICATIONS OF ARTIFICIAL INTELLIGENCE CONFERENCE. INNOVATIVE APPLICATIONS OF ARTIFICIAL INTELLIGENCE CONFERENCE 2023; 37:15724-15730. [PMID: 37637073 PMCID: PMC10457015 DOI: 10.1609/aaai.v37i13.26866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
While dental disease is largely preventable, professional advice on optimal oral hygiene practices is often forgotten or abandoned by patients. Therefore patients may benefit from timely and personalized encouragement to engage in oral self-care behaviors. In this paper, we develop an online reinforcement learning (RL) algorithm for use in optimizing the delivery of mobile-based prompts to encourage oral hygiene behaviors. One of the main challenges in developing such an algorithm is ensuring that the algorithm considers the impact of current actions on the effectiveness of future actions (i.e., delayed effects), especially when the algorithm has been designed to run stably and autonomously in a constrained, real-world setting characterized by highly noisy, sparse data. We address this challenge by designing a quality reward that maximizes the desired health outcome (i.e., high-quality brushing) while minimizing user burden. We also highlight a procedure for optimizing the hyperparameters of the reward by building a simulation environment test bed and evaluating candidates using the test bed. The RL algorithm discussed in this paper will be deployed in Oralytics. To the best of our knowledge, Oralytics is the first mobile health study utilizing an RL algorithm designed to prevent dental disease by optimizing the delivery of motivational messages supporting oral self-care behaviors.
Collapse
Affiliation(s)
| | | | | | - Vivek Shetty
- Schools of Dentistry & Engineering, University of California, Los Angeles
| | | | | |
Collapse
|
44
|
Thompson D, Mirabile Y, Islam N, Callender C, Musaad SMA, Miranda J, Moreno JP, Dave JM, Baranowski T. Diet Quality among Pre-Adolescent African American Girls in a Randomized Controlled Obesity Prevention Intervention Trial. Nutrients 2023; 15:2716. [PMID: 37375620 DOI: 10.3390/nu15122716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Consuming an unhealthy diet increases health risks. This study assessed the impact of a culturally adapted behaviorally innovative obesity prevention intervention (The Butterfly Girls and the Quest for Founder's Rock) on diet quality in pre-adolescent non-Hispanic Black/African American girls. The RCT consisted of three groups (experimental, comparison, and waitlist control); block randomization allocated participants to each group. The two treatment groups varied in terms of whether or not they set goals. Data were collected at baseline (prior to receiving the intervention), post 1 (3 months post-baseline), and post 2 (6 months post-baseline). Two dietitian-assisted 24 h dietary recalls were collected at each timepoint. Healthy Eating Index 2015 (HEI-2015) was used to determine diet quality. A total of 361 families were recruited; 342 completed baseline data collection. No significant differences in overall HEI score or component scores were observed. To attain more equitable health outcomes, future efforts to promote dietary intake change among at-risk children should explore other behavior change procedures and employ more child-friendly dietary assessment methods.
Collapse
Affiliation(s)
- Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, USA
| | - Yiming Mirabile
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, USA
| | - Noemi Islam
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, USA
| | - Chishinga Callender
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, USA
| | - Salma M A Musaad
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, USA
| | - Julie Miranda
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, USA
| | - Jennette P Moreno
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, USA
| | - Jayna M Dave
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, USA
| | - Tom Baranowski
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, USA
| |
Collapse
|
45
|
McCurdy LY, Loya JM, Hart-Derrick VR, Young GC, Kiluk BD, Potenza MN. Smartphone Apps for Problem Gambling: A Review of Content and Quality. CURRENT ADDICTION REPORTS 2023; 10:178-186. [PMID: 38463534 PMCID: PMC10919356 DOI: 10.1007/s40429-023-00479-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 03/12/2024]
Abstract
Purpose of review Problem gambling can have profound consequences for affected individuals, yet only a small proportion of people with problem gambling seek treatment. Mobile phone applications (apps) may provide an effective and scalable therapeutic option. The purpose of this study was to evaluate publicly available mobile apps aimed at improving problematic gambling behavior. Recent findings To date, there are no published studies that have evaluated the quality of publicly available smartphone apps for problem gambling in the US. There is thus a significant gap in knowledge of existing apps for addressing problem gambling. Summary This study included a review of 14 problem-gambling-specific apps. Apps that incorporated cognitive-behavioral therapy concepts and in-app communities were associated with better aesthetics and information quality scores. Additionally, in-app communities were associated with better engagement scores. Our results highlight the importance of evidence-based and engaging features in apps designed to help people with problem gambling.
Collapse
Affiliation(s)
- Li Yan McCurdy
- Division of Prevention and Community Research, Yale
University School of Medicine, New Haven, CT 06511, USA
- Department of Psychiatry, Yale University School of
Medicine, New Haven, CT, 06510, USA
| | - Jennifer M Loya
- Department of Psychiatry, Yale University School of
Medicine, New Haven, CT, 06510, USA
| | | | - Griffin C Young
- Department of Computer Science, Stanford University School
of Engineering, Stanford, CA 94305
| | - Brian D Kiluk
- Department of Psychiatry, Yale University School of
Medicine, New Haven, CT, 06510, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of
Medicine, New Haven, CT, 06510, USA
- Child Study Center, Yale University School of Medicine, New
Haven, CT 06520, USA
- Department of Neuroscience, Yale University School of
Medicine, New Haven, CT 06510, USA
- The Connecticut Council on Problem Gambling, Wethersfield,
CT 06109, USA
- The Connecticut Mental Health Center, New Haven, CT 06519,
USA
| |
Collapse
|
46
|
Aydin A, Gürsoy A, Karal H. Mobile care app development process: using the ADDIE model to manage symptoms after breast cancer surgery (step 1). Discov Oncol 2023; 14:63. [PMID: 37160467 PMCID: PMC10169965 DOI: 10.1007/s12672-023-00676-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/28/2023] [Indexed: 05/11/2023] Open
Abstract
The use of mobile applications is widespread in patient monitoring or education today. This study aims to describe the design and development process of a mobile app that supports patient self-care after breast cancer surgery. We used the ADDIE model to develop and test the mobile app. ADDIE (Analysis, Design, Development, Implementation, Evaluation) is a systematic approach based on a standard instructional design model for creating training materials. The model consists of five phases, each with its own set of steps. Once the steps within each phase are completed, the model progresses to the next phase, ultimately resulting in a "usable" product. Different team collaborations were established within each phase, and support was obtained from multiple experts during the design process. Thanks to this model, the information that patients need was transformed into a technological product. This article, which explains the stages of the product design process for mobile applications, provides information that may be helpful to researchers working on similar products.
Collapse
Affiliation(s)
- Aydanur Aydin
- Faculty of Health Sciences, Nursing Department, Gumushane University, Gumushane, Turkey.
| | - Ayla Gürsoy
- Faculty of Health Sciences, Nursing Department, Antalya Bilim University, Antalya, Turkey
| | - Hasan Karal
- Faculty of Education, Computer and Instructional Technologies Education, Trabzon University, Trabzon, Turkey
| |
Collapse
|
47
|
Gudmundsdóttir SL, Ballarini T, Ámundadóttir ML, Mészáros J, Eysteinsdottir JH, Thorleifsdottir RH, Hrafnkelsdóttir SK, Helgadottir H, Oddsson S, Silverberg JI. Engagement, Retention and Acceptability in a Digital Health Program for Atopic Dermatitis: Prospective Interventional Study. JMIR Form Res 2023. [PMID: 36975050 DOI: 10.2196/41227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Patients with Atopic Dermatitis (AD) can experience chronic eczema with pruritus, skin pain, sleep problems, anxiety, and other problems that reduce their quality of life (QoL). Current treatments aim to improve these symptoms and reduce inflammation, but poor treatment adherence and disease understanding are key concerns in the long-term management of AD. Digital therapeutics can help with these, and support patients towards a healthier lifestyle to improve their overall QoL. OBJECTIVE To test the feasibility of a digital health program tailored for AD through program engagement, retention and acceptability. METHODS Adults with AD were recruited in Iceland for a six-week digital health program delivered through a smartphone app. Key components of the digital program were disease and trigger education, medication reminders, patient-reported outcomes (PROs) on energy levels, stress levels, and quality of sleep (referred to as QoL PROs), AD symptom PROs, guided meditation, and healthy lifestyle coaching. The primary outcome was program feasibility, as assessed by in-app retention and engagement. User satisfaction was assessed by the mHealth App Usability Questionnaire (MAUQ). RESULTS Twenty-one patients were recruited (17 female, mean age: 31 years); 20 (95%) completed the program. On average, users were active in the app 6.5 days per week and completed 8.2 missions per day. The education content, medication reminders, and PROs had high user engagement and retention; all users who were exposed to the QoL PROs (n=17) interacted with these, and 20/21 (95%) users continuously engaged with the education missions, medication missions, and symptom PROs. Continued engagement with the step counter and mind missions among exposed users was lower (17/21 and 13/20 participants respectively). Medication reminder and education task completion remained high over time (at least 18/20, 90%), but weekly interactions declined. All assigned users completed AD symptom PROs on weeks 1-5 and only one did not do so on week 6; the reported number and total severity of AD symptoms reduced during the program. Regarding the QoL PROs, 16/17 (94%) and 14/17 (82%) users interacted with these at least 3 times in the first and last week of the program respectively, and all reported improvements over time. User satisfaction was high, with a total score of 6.2/7. CONCLUSIONS We found high overall engagement and retention in a targeted digital health program among patients with AD, as well as high compliance with missions relating to medication reminders, patient education, and PROs. Symptom number and severity was reduced and QoL PROs improved over time. We conclude that a digital health program is feasible and may provide added benefits for patients with AD, including the tracking and improvement of AD symptoms. CLINICALTRIAL
Collapse
Affiliation(s)
| | | | | | - Judit Mészáros
- Sidekick Health Digital Therapeutics, Oberwallstraße 6, Berlin, DE
| | | | | | | | | | | | - Jonathan I Silverberg
- School of Medicine and Health Sciences, George Washington University, Washington, US
| |
Collapse
|
48
|
Possemato K, Johnson E, Barrie K, Ghaus S, Noronha D, Wade M, Greenbaum MA, Rosen C, Cloitre M, Owen J, Jain S, Beehler G, Prins A, Seal K, Kuhn E. A Randomized Clinical Trial of Clinician-Supported PTSD Coach in VA Primary Care Patients. J Gen Intern Med 2023:10.1007/s11606-023-08130-6. [PMID: 36932268 PMCID: PMC10022983 DOI: 10.1007/s11606-023-08130-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is common in primary care patients; however, evidence-based treatments are typically only available in specialty mental healthcare settings and often not accessed. OBJECTIVE To test the effectiveness of a brief primary care-based treatment, Clinician-Supported PTSD Coach (CS PTSD Coach) was compared with Primary Care Mental Health Integration-Treatment as Usual (PCMHI-TAU) in (1) reducing PTSD severity, (2) engaging veterans in specialty mental health care, and (3) patient satisfaction with care. DESIGN Multi-site randomized pragmatic clinical trial. PARTICIPANTS A total of 234 veterans with PTSD symptoms who were not currently accessing PTSD treatment. INTERVENTION CS PTSD Coach was designed to be implemented in Veterans Affairs PCMHI and combines mental health clinician support with the "PTSD Coach" mobile app. Four 30-min sessions encourage daily use of symptom management strategies. MAIN MEASURES PTSD severity was measured by clinician-rated interviews pre- and post-treatment (8 weeks). Self-report measures assessed PTSD, depression, and quality of life at pretreatment, posttreatment, and 16- and 24-week follow-ups, and patient satisfaction at post-treatment. Mental healthcare utilization was extracted from medical records. KEY RESULTS Clinician-rated PTSD severity did not differ by condition at post-treatment. CS PTSD Coach participants improved more on patient-reported PTSD severity at post-treatment than TAU participants (D = .28, p = .021). Coach participants who continued to have problematic PTSD symptoms at post-treatment were not more likely to engage in 2 sessions of specialty mental health treatment than TAU participants. Coach participants engaged in 74% more sessions in the intervention and reported higher treatment satisfaction than TAU participants (p < .001). CONCLUSIONS A structured 4-session intervention designed to align with patient preferences for care resulted in more patient-reported PTSD symptom relief, greater utilization of mental health treatment, and overall treatment satisfaction than TAU, but not more clinician-rated PTSD symptom relief or engagement in specialty mental health.
Collapse
Affiliation(s)
- Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.
| | - Emily Johnson
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Kimberly Barrie
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | | | | | - Michael Wade
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Mark A Greenbaum
- National Center for PTSD, Palo Alto, CA, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Craig Rosen
- National Center for PTSD, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Marylene Cloitre
- National Center for PTSD, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jason Owen
- National Center for PTSD, Palo Alto, CA, USA
| | - Shaili Jain
- National Center for PTSD, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Gregory Beehler
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | | | - Karen Seal
- San Francisco VA Health Care System, San Francisco, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Eric Kuhn
- National Center for PTSD, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
49
|
Schwarz A, Winkens LHH, de Vet E, Ossendrijver D, Bouwsema K, Simons M. Design Features Associated With Engagement in Mobile Health Physical Activity Interventions Among Youth: Systematic Review of Qualitative and Quantitative Studies. JMIR Mhealth Uhealth 2023; 11:e40898. [PMID: 36877551 PMCID: PMC10028523 DOI: 10.2196/40898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/02/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Globally, 81% of youth do not meet the physical activity (PA) guidelines. Youth of families with a low socioeconomic position are less likely to meet the recommended PA guidelines. Mobile health (mHealth) interventions are preferred by youth over traditional in-person approaches and are in line with their media preferences. Despite the promise of mHealth interventions in promoting PA, a common challenge is to engage users in the long term or effectively. Earlier reviews highlighted the association of different design features (eg, notifications and rewards) with engagement among adults. However, little is known about which design features are important for increasing engagement among youth. OBJECTIVE To inform the design process of future mHealth tools, it is important to investigate the design features that can yield effective user engagement. This systematic review aimed to identify which design features are associated with engagement in mHealth PA interventions among youth who were aged between 4 and 18 years. METHODS A systematic search was conducted in EBSCOhost (MEDLINE, APA PsycINFO, and Psychology & Behavioral Sciences Collection) and Scopus. Qualitative and quantitative studies were included if they documented design features associated with engagement. Design features and related behavior change techniques and engagement measures were extracted. Study quality was assessed according to the Mixed Method Assessment Tool, and one-third of all screening and data extraction were double coded by a second reviewer. RESULTS Studies (n=21) showed that various features were associated with engagement, such as a clear interface, rewards, multiplayer game mode, social interaction, variety of challenges with personalized difficulty level, self-monitoring, and variety of customization options among others, including self-set goals, personalized feedback, progress, and a narrative. In contrast, various features need to be carefully considered while designing mHealth PA interventions, such as sounds, competition, instructions, notifications, virtual maps, or self-monitoring, facilitated by manual input. In addition, technical functionality can be considered as a prerequisite for engagement. Research addressing youth from low socioeconomic position families is very limited with regard to engagement in mHealth apps. CONCLUSIONS Mismatches between different design features in terms of target group, study design, and content translation from behavior change techniques to design features are highlighted and set up in a design guideline and future research agenda. TRIAL REGISTRATION PROSPERO CRD42021254989; https://tinyurl.com/5n6ppz24.
Collapse
Affiliation(s)
- Ayla Schwarz
- Department of Social Sciences, Chair Group Consumption & Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
| | - Laura H H Winkens
- Department of Social Sciences, Chair Group Consumption & Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
| | - Emely de Vet
- Department of Social Sciences, Chair Group Consumption & Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
| | - Dian Ossendrijver
- Department of Social Sciences, Chair Group Consumption & Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
| | - Kirsten Bouwsema
- Department of Social Sciences, Chair Group Consumption & Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
| | - Monique Simons
- Department of Social Sciences, Chair Group Consumption & Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
| |
Collapse
|
50
|
Modi AC, Patel AD, Mara CA, Schmidt M, Tenney JR, Stevens J. Pilot randomized controlled clinical trial of an adherence social norms intervention for adolescents with epilepsy. Epilepsy Behav 2023; 140:109082. [PMID: 36731289 PMCID: PMC9998352 DOI: 10.1016/j.yebeh.2022.109082] [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] [Received: 11/07/2022] [Revised: 12/21/2022] [Accepted: 12/31/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Non-adherence to anti-seizure medications (ASMs) is common for adolescents with epilepsy, with potentially devastating consequences. Existing adherence interventions in epilepsy do not meet the unique challenges faced by adolescents. Leveraging social norms capitalizes on the increased importance of peer influence while simultaneously targeting the low motivation levels of many adolescents. The current study examined the feasibility, acceptability, and satisfaction of a social norms adherence intervention in adolescents with epilepsy. METHODS A pilot RCT of a mHealth social norms intervention was conducted with adolescents with epilepsy who demonstrated non-adherence (≤95% adherence) during baseline. Adolescents were randomized to either (1) mHealth social norms (reminders, individualized and social norms adherence feedback) or (2) control (reminders and individualized adherence feedback). Primary outcomes included feasibility, acceptability, and satisfaction. Exploratory outcomes included electronically monitored adherence, seizure severity, and health-related quality of life (HRQOL). RESULTS One hundred four adolescents were recruited (53% female; Mage = 15.4 ± 1.4 years; 81% White: Non-Hispanic; 5% Black, 10% Bi/Multiracial; 2% White: Hispanic; 1% Other: Hispanic; 1% Bi/Multiracial-Hispanic). Forty-five percent screen-failed due to high adherence, 16% withdrew, and 38% were randomized to treatment (n = 19) or control (n = 21). Recruitment (75%), retention (78%), and treatment satisfaction were moderately high. Engagement with the intervention was moderate, with 64% of participants engaging with intervention notifications. Exploratory analyses revealed that after controlling for COVID-19 impact, the social norms intervention group maintained higher adherence over time compared to the control group. Small to moderate effect sizes were noted for seizure severity and HRQOL between groups. CONCLUSION This pilot intervention appeared feasible and acceptable. Increases in adherence in the treatment versus control group were modest, but a future larger more adequately powered study is needed to detect effects. Notably, it appeared the COVID pandemic influenced adherence behaviors during our trial.
Collapse
Affiliation(s)
- Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, 3333 Burnet Ave., Cincinnati, OH 45229, United States; University of Cincinnati, College of Medicine, Cincinnati, OH, United States.
| | - Anup D Patel
- Nationwide Children's Hospital, 700 Children's Drive, Near East Office Building, 3rd Floor, Columbus, OH 43205, United States; The Ohio State, Department of Pediatrics, 700 Children's Drive, Near East Office Building, 3rd Floor, Columbus, OH 43205, United States.
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, 3333 Burnet Ave., Cincinnati, OH 45229, United States; University of Cincinnati, College of Medicine, Cincinnati, OH, United States.
| | - Matthew Schmidt
- College of Education, University of Florida, 2423 Normal Hall, Gainesville, FL 32611, United States.
| | - Jeffrey R Tenney
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, 3333 Burnet Ave., Cincinnati, OH 45229, United States; University of Cincinnati, College of Medicine, Cincinnati, OH, United States.
| | - Jack Stevens
- Nationwide Children's Hospital, 700 Children's Drive, Near East Office Building, 3rd Floor, Columbus, OH 43205, United States; The Ohio State, Department of Pediatrics, 700 Children's Drive, Near East Office Building, 3rd Floor, Columbus, OH 43205, United States.
| |
Collapse
|