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Kanuri N, Arora P, Talluru S, Colaco B, Dutta R, Rawat A, Taylor BC, Manjula M, Newman MG. Examining the initial usability, acceptability and feasibility of a digital mental health intervention for college students in India. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2019; 55:657-673. [PMID: 31867730 DOI: 10.1002/ijop.12640] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 11/18/2019] [Indexed: 11/10/2022]
Abstract
Generalised anxiety disorder (GAD) is prevalent among college students in India; however, barriers like stigma, treatment accessibility and cost prevent engagement in treatment. Web- and mobile-based, or digital, mental health interventions have been proposed as a potential solution to increasing treatment access. With the ultimate goal of developing an engaging digital mental health intervention for university students in India, the current study sought to understand students' reactions to a culturally and digitally adapted evidence-based cognitive behavioural therapy (CBT) for GAD intervention. Specifically, through theatre testing and focus groups with a non-clinical sample of 15 college students in India, the present study examined initial usability, acceptability and feasibility of the "Mana Maali Digital Anxiety Program." Secondary objectives comprised identifying students' perceived barriers to using the program and eliciting recommendations. Results indicated high usability, with the average usability rating ranking in the top 10% of general usability scores. Participants offered actionable changes to improve usability and perceived acceptability among peers struggling with mental health issues. Findings highlight the benefits of offering digital resources that circumvent barriers associated with accessing traditional services. Results build on existing evidence that digital interventions can be a viable means of delivering mental healthcare to large, defined populations.
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Affiliation(s)
- Nitya Kanuri
- School of Management & School of Public Health, Yale University, New Haven, CT, USA
| | - Prerna Arora
- Department of Health and Behavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Sai Talluru
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Bona Colaco
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Rohan Dutta
- Electrical and Electronics Engineering, BITS Pilani, Goa Campus, Goa, India
| | | | - Barr C Taylor
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA.,Department of Psychiatry (emeritus), Stanford University, Stanford, CA, USA
| | - M Manjula
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - Michelle G Newman
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
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Mehrotra S, Sudhir P, Rao G, Thirthalli J, Srikanth TK. Development and Pilot Testing of an Internet-Based Self-Help Intervention for Depression for Indian Users. Behav Sci (Basel) 2018; 8:bs8040036. [PMID: 29565278 PMCID: PMC5946095 DOI: 10.3390/bs8040036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/25/2018] [Accepted: 03/16/2018] [Indexed: 12/28/2022] Open
Abstract
There is a dearth of published research on uptake and utility of mental health apps in India, despite a rising global trend in the application of technology in the field of mental health. We describe the development and pilot testing of a self-help intervention for depression, PUSH-D (Practice and Use Self-Help for Depression) for urban Indians. This guided self-help app, with essential and optional zone sections, was developed to provide a comprehensive coverage of therapeutic strategies drawn from cognitive behavior therapy, interpersonal therapy, supportive psychotherapy, and positive psychology. Pilot testing was carried out using a single group pre-, post- and follow-up design in 78 eligible participants. Participants were typically young adults with major depression or dysthymia and significant impairment in functioning. Almost two-thirds of the participants had never sought professional mental health help. Significant reductions in depression and improvement in the functioning and well-being were notedon standardized measures in participants completing all 10 essential zone sections. These gains were maintained at follow-up. The results were similar for partial completers, who completed fiveout of the 10 essential sections. PUSH-D is one of the first indigenously developed self-help apps for depression and it shows promise in reducing the treatment gap for depression in India.
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Affiliation(s)
- Seema Mehrotra
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India.
| | - Paulomi Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India.
| | - Girish Rao
- Department of Epidemiology, Center for Public health, NIMHANS, Bangalore 560029, India.
| | | | - T K Srikanth
- E-health Research Center, IIIT, Bangalore 560100, India.
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Rodriguez-Paras C, Tippey K, Brown E, Sasangohar F, Creech S, Kum HC, Lawley M, Benzer JK. Posttraumatic Stress Disorder and Mobile Health: App Investigation and Scoping Literature Review. JMIR Mhealth Uhealth 2017; 5:e156. [PMID: 29074470 PMCID: PMC5680516 DOI: 10.2196/mhealth.7318] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/05/2017] [Accepted: 08/29/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a prevalent mental health issue among veterans. Access to PTSD treatment is influenced by geographic (ie, travel distance to facilities), temporal (ie, time delay between services), financial (ie, eligibility and cost of services), and cultural (ie, social stigma) barriers. OBJECTIVE The emergence of mobile health (mHealth) apps has the potential to bridge many of these access gaps by providing remote resources and monitoring that can offer discrete assistance to trauma survivors with PTSD and enhance patient-clinician relationships. In this study, we investigate the current mHealth capabilities relevant to PTSD. METHODS This study consists of two parts: (1) a review of publicly available PTSD apps designed to determine the availability of PTSD apps, which includes more detailed information about three dominant apps and (2) a scoping literature review performed using a systematic method to determine app usage and efforts toward validation of such mHealth apps. App usage relates to how the end users (eg, clinicians and patients) are interacting with the app, whereas validation is testing performed to ensure the app's purpose and specifications are met. RESULTS The results suggest that though numerous apps have been developed to aid in the diagnosis and treatment of PTSD symptoms, few apps were designed to be integrated with clinical PTSD treatment, and minimal efforts have been made toward enhancing the usability and validation of PTSD apps. CONCLUSIONS These findings expose the need for studies relating to the human factors evaluation of such tools, with the ultimate goal of increasing access to treatment and widening the app adoption rate for patients with PTSD.
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Affiliation(s)
- Carolina Rodriguez-Paras
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Kathryn Tippey
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elaine Brown
- Health Science Center, School of Public Health, Louisiana State University, New Orleans, LA, United States
| | - Farzan Sasangohar
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station, TX, United States
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Suzannah Creech
- VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Health Care System, Waco, TX, United States
| | - Hye-Chung Kum
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station, TX, United States
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Mark Lawley
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station, TX, United States
| | - Justin K Benzer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Health Care System, Waco, TX, United States
- Department of Psychiatry, Dell Medical School, University of Texas, Austin, TX, United States
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Internet and mobile technologies: addressing the mental health of trauma survivors in less resourced communities. Glob Ment Health (Camb) 2017; 4:e16. [PMID: 29230312 PMCID: PMC5719483 DOI: 10.1017/gmh.2017.11] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/02/2017] [Accepted: 06/14/2017] [Indexed: 02/01/2023] Open
Abstract
Internet and mobile technologies offer potentially critical ways of delivering mental health support in low-resource settings. Much evidence indicates an enormous negative impact of mental health problems in low- and middle-income countries (LMICs), and many of these problems are caused, or worsened, by exposure to wars, conflicts, natural and human-caused disasters, and other traumatic events. Though specific mental health treatments have been found to be efficacious and cost-effective for low-resource settings, most individuals living in these areas do not have access to them. Low-intensity task-sharing interventions will help, but there is a limit to the scalability and sustainability of human resources in these settings. To address the needs of trauma survivors, it will be important to develop and implement Internet and mobile technology resources to help reduce the scarcity, inequity, and inefficiency of current mental health services in LMICs. Mobile and Internet resources are experiencing a rapid growth in LMICs and can help address time, stigma, and cost barriers and connect those who have been socially isolated by traumatic events. This review discusses current research in technological interventions in low-resource settings and outlines key issues and future challenges and opportunities. Though formidable challenges exist for large-scale deployment of mobile and Internet mental health technologies, work to date indicates that these technologies are indeed feasible to develop, evaluate, and deliver to those in need of mental health services, and that they can be effective.
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Ruzek JI, Kuhn E, Jaworski BK, Owen JE, Ramsey KM. Mobile mental health interventions following war and disaster. Mhealth 2016; 2:37. [PMID: 28293610 PMCID: PMC5344166 DOI: 10.21037/mhealth.2016.08.06] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/22/2016] [Indexed: 01/18/2023] Open
Abstract
Mobile technologies offer potentially critical ways of delivering mental health support to those experiencing war, ethnic conflict, and human-caused and natural disasters. Research on Internet interventions suggests that effective mobile mental health technologies can be developed, and there are early indications that they will be acceptable to war and disaster survivors, and prove capable of greatly increasing the reach of mental health services. Promising mhealth interventions include video teleconferencing, text messaging, and smartphone-based applications. In addition, a variety of social media platforms has been used during and immediately after disasters to increase agility in responding, and strengthen community and individual resilience. Globally, PTSD Coach has been downloaded over 243,000 times in 96 countries, and together with large-scale use of social media for communication during disasters, suggests the potential for reach of app technology. In addition to enabling improved self-management of post-trauma problems, mobile phone interventions can also enhance delivery of face-to-face care by mental health providers and increase the effectiveness of peer helpers and mutual aid organizations. More research is needed to establish the efficacy of mhealth interventions for those affected by war and disaster. Research should also focus on the identification of active elements and core processes of change, determination of effective ways of increasing adoption and engagement, and explore ways of combining the various capabilities of mobile technologies to maximize their impact.
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Affiliation(s)
- Josef I Ruzek
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Eric Kuhn
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Beth K Jaworski
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Jason E Owen
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Kelly M Ramsey
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
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