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Ma Z, Mei Y, Su Z. Understanding the Benefits and Challenges of Using Large Language Model-based Conversational Agents for Mental Well-being Support. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:1105-1114. [PMID: 38222348 PMCID: PMC10785945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Conversational agents powered by large language models (LLM) have increasingly been utilized in the realm of mental well-being support. However, the implications and outcomes associated with their usage in such a critical field remain somewhat ambiguous and unexplored. We conducted a qualitative analysis of 120 posts, encompassing 2917 user comments, drawn from the most popular subreddit focused on mental health support applications powered by large language models (u/Replika). This exploration aimed to shed light on the advantages and potential pitfalls associated with the integration of these sophisticated models in conversational agents intended for mental health support. We found the app (Replika) beneficial in offering on-demand, non-judgmental support, boosting user confidence, and aiding self-discovery. Yet, it faced challenges in filtering harmful content, sustaining consistent communication, remembering new information, and mitigating users' overdependence. The stigma attached further risked isolating users socially. We strongly assert that future researchers and designers must thoroughly evaluate the appropriateness of employing LLMs for mental well-being support, ensuring their responsible and effective application.
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Affiliation(s)
- Zilin Ma
- Harvard University, Cambridge, MA
| | | | - Zhaoyuan Su
- University of California, Irvine, Irvine, CA
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2
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Llaneza DH, Llaneza AJ, Kozlov E. Perceived Benefits and Barriers of mHealth Mindfulness Use for Caregivers of Older Adults with Cognitive Impairment: A Qualitative Exploration. Clin Gerontol 2024; 47:66-77. [PMID: 36502294 DOI: 10.1080/07317115.2022.2154728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Mobile (mHealth) mindfulness-based interventions have the potential to be feasible, acceptable, effective, and scalable interventions for caregivers of people living with cognitive impairment. This qualitative study of caregivers of older adults with cognitive impairment explored caregivers' experiences using a mindfulness therapy mobile application. METHODS Fifteen caregivers were interviewed using a semi-structured interview guide. Analysis was guided by the phenomenological approach and inductive-deductive analysis. RESULTS Six themes were generated from the data: convenience, barriers, perceived helpfulness, useful features, suggested app improvements, and skill transfer. Caregivers reported that the app was easy to use with many perceived benefits. Caregivers also noted some barriers to using the app. CONCLUSIONS This study revealed that self-directed mHealth delivered mindfulness therapy may be a promising intervention for the caregivers involved in the study. Having the ability to use the app anywhere and at any time was a prominent reason for continued regular use for the participants. This was especially important to some caregivers during the COVID-19 pandemic. The barriers discussed by the caregivers are important considerations for future app-based interventions for caregivers. CLINICAL IMPLICATIONS Clinicians can consider recommending mHealth mindfulness therapy to caregivers as a tool to provide caregivers with additional support.
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Affiliation(s)
- Danielle H Llaneza
- Rutgers University, School of Public Health, Department of Health, Behavior, Society, and Policy, Rutgers University, Piscataway, New Jersey, USA
| | - Amanda J Llaneza
- Department of Biostatistics & Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Elissa Kozlov
- Rutgers University, School of Public Health, Department of Health, Behavior, Society, and Policy, Rutgers University, Piscataway, New Jersey, USA
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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.
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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.
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McCue M, Khatib R, Kabir C, Blair C, Fehnert B, King J, Spalding A, Zaki L, Chrones L, Roy A, Kemp DE. User-Centered Design of a Digitally Enabled Care Pathway in a Large Health System: Qualitative Interview Study. JMIR Hum Factors 2023; 10:e42768. [PMID: 37494099 PMCID: PMC10413250 DOI: 10.2196/42768] [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: 09/20/2022] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a leading cause of disability worldwide. Management of chronic conditions such as MDD can be improved by enhanced patient engagement, measurement-based care (MBC), and shared decision-making (SDM). A user-centered design approach can improve the understanding of the patient journey and care team workflows and thus aid the development of digital health care innovations optimized for the needs of patients living with MDD and their primary care teams. OBJECTIVE This study aims to use qualitative research methods for the user-centered design of a digitally enabled MDD care platform, PathwayPlatform, intended to enhance patient engagement, MBC, and SDM. METHODS Insights were gathered through 2 stages of qualitative interviews by a study team with expertise in qualitative research and user-centered design methods. Thematic analysis was used to generate an overarching understanding of a set of shared experiences, thoughts, or behaviors across a broad qualitative data set, including transcripts of interviews, to allow both inductive and deductive insights to emerge. Thematic analysis of interviews was supported by Dedoose (SocioCultural Research Consultants, LLC), a qualitative data analysis software tool that enables systematized coding. Findings and insights were presented based on code frequency, salience, and relevance to the research project. RESULTS In stage 1, interviews were conducted with 20 patients living with MDD and 15 health care providers from September 2018 to January 2019 to understand the experiences with and perceptions about the initial functionality of the Pathway app while also exploring the perceptions about potential additional features and functionality. Feedback about care team workflows and treatment approaches was collected in stage-2 interviews with 36 health care providers at 8 primary care sites. Inductive and deductive thematic analyses revealed several themes related to app functionality, patient-provider engagement, workflow integration, and patient education. Both patients and their care teams perceived the remote tracking of patient-reported outcomes via digital tools to be clinically useful and reliable and to promote MBC and SDM. However, there was emphasis on the need to enhance the flow of real-time data shared with the care team, improve trend visualizations, and integrate the data within the existing clinical workflow and educational programs for patients and their care teams. User feedback was incorporated into the iterative development of the Pathway app. CONCLUSIONS Ongoing communication with patients living with MDD and their care teams provided an opportunity for user-centric developmental iterations of the Pathway Platform. Key insights led to further development of the patient-facing and care team-facing visit preparation features, collaborative goal-setting and goal-tracking features, patient-reported outcome summaries, and trend visualizations. The result is an enhanced digital platform with the potential to improve treatment outcomes and provide patients living with MDD additional support throughout their treatment journey.
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Affiliation(s)
- Maggie McCue
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Rasha Khatib
- Advocate Aurora Research Institute, Advocate Health Care, Downers Grove, IL, United States
| | - Christopher Kabir
- Advocate Aurora Research Institute, Advocate Health Care, Downers Grove, IL, United States
| | - Chris Blair
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Ben Fehnert
- Cognition Kit, Cambridge, United Kingdom
- Ctrl Group / Fora Health, London, United Kingdom
| | - James King
- Ctrl Group / Fora Health, London, United Kingdom
| | | | - Lara Zaki
- Ctrl Group / Fora Health, London, United Kingdom
| | - Lambros Chrones
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Anit Roy
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - David E Kemp
- Advocate Aurora Health, Downers Grove, IL, United States
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Guerrero-Jiménez M, Ruiz M, Gutiérrez-Rojas L, Jiménez-Muñoz L, Baca-Garcia E, Porras-Segovia A. Use of new technologies for the promotion of physical activity in patients with mental illness: A systematic review. World J Psychiatry 2023; 13:182-190. [PMID: 37123096 PMCID: PMC10130960 DOI: 10.5498/wjp.v13.i4.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/14/2023] [Accepted: 03/21/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Physical exercise is an underutilized tool for the management of mental disorders. New technologies have made a breakthrough in health care, and one of its possible applications (apps) could be that of customizing exercise programs for special populations, such as patients with mental disorders. However, the app of the so-called e-health to mental health care is still limited.
AIM To know the efficacy of apps to promote physical activity in patients with mental disorders.
METHODS We conducted a systematic review of the PubMed and Embase databases with the aim of exploring the use of new technologies for the enhancement of physical exercise in patients with a psychiatric illness. Following the selection process, 10 articles were included in the review.
RESULTS The most commonly used devices in this type of intervention are wearable devices and web platforms. Good results in terms of effectiveness and acceptability were obtained in most of the studies.
CONCLUSION Our findings suggest that the use of new technologies in mental health represents a feasible strategy with great potential in clinical practice.
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Affiliation(s)
| | - Marta Ruiz
- Department of Psychiatry, Hospital Rey Juan Carlos, Móstoles 28933, Madrid, Spain
| | | | - Laura Jiménez-Muñoz
- Department of Psychiatry, Hospital Universitario Jiménez Díaz, Madrid 28040, Spain
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Eysenbach G, Amado S, Jasman M, Ervin A, Rhodes JE. Providing Human Support for the Use of Digital Mental Health Interventions: Systematic Meta-review. J Med Internet Res 2023; 25:e42864. [PMID: 36745497 PMCID: PMC9941905 DOI: 10.2196/42864] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/23/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Digital mental health interventions (DMHIs) have been increasingly deployed to bridge gaps in mental health care, particularly given their promising efficacy. Nevertheless, attrition among DMHI users remains high. In response, human support has been studied as a means of improving retention to and outcomes of DMHIs. Although a growing number of studies and meta-analyses have investigated the effects of human support for DMHIs on mental health outcomes, systematic empirical evidence of its effectiveness across mental health domains remains scant. OBJECTIVE We aimed to summarize the results of meta-analyses of human support versus no support for DMHI use across various outcome domains, participant samples, and support providers. METHODS We conducted a systematic meta-review of meta-analyses, comparing the effects of human support with those of no support for DMHI use, with the goal of qualitatively summarizing data across various outcome domains, participant samples, and support providers. We used MEDLINE, PubMed, and PsycINFO electronic databases. Articles were included if the study had a quantitative meta-analysis study design; the intervention targeted mental health symptoms and was delivered via a technology platform (excluding person-delivered interventions mediated through telehealth, text messages, or social media); the outcome variables included mental health symptoms such as anxiety, depression, stress, posttraumatic stress disorder symptoms, or a number of these symptoms together; and the study included quantitative comparisons of outcomes in which human support versus those when no or minimal human support was provided. RESULTS The results of 31 meta-analyses (505 unique primary studies) were analyzed. The meta-analyses reported 45 effect sizes; almost half (n=22, 48%) of them showed that human-supported DMHIs were significantly more effective than unsupported DMHIs. A total of 9% (4/45) of effect sizes showed that unsupported DMHIs were significantly more effective. No clear patterns of results emerged regarding the efficacy of human support for the outcomes assessed (including anxiety, depression, posttraumatic stress disorder, stress, and multiple outcomes). Human-supported DMHIs may be more effective than unsupported DMHIs for individuals with elevated mental health symptoms. There were no clear results regarding the type of training for those providing support. CONCLUSIONS Our findings highlight the potential of human support in improving the effects of DMHIs. Specifically, evidence emerged for stronger effects of human support for individuals with greater symptom severity. There was considerable heterogeneity across meta-analyses in the level of detail regarding the nature of the interventions, population served, and support delivered, making it difficult to draw strong conclusions regarding the circumstances under which human support is most effective. Future research should emphasize reporting detailed descriptions of sample and intervention characteristics and describe the mechanism through which they believe the coach will be most useful for the DMHI.
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Affiliation(s)
| | - Selen Amado
- Center for Evidence-Based Mentoring, University of Massachusetts Boston, Boston, MA, United States
| | - Megyn Jasman
- Center for Evidence-Based Mentoring, University of Massachusetts Boston, Boston, MA, United States
| | - Ariel Ervin
- Center for Evidence-Based Mentoring, University of Massachusetts Boston, Boston, MA, United States
| | - Jean E Rhodes
- Center for Evidence-Based Mentoring, University of Massachusetts Boston, Boston, MA, United States
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Werntz A, Jasman M, Simeon K, Gunasekaran H, Yowell C, Rhodes JE. Implementation of a Technology-Enhanced Peer Mentor Referral System for First-Year University Students. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2023; 8:1-15. [PMID: 36777164 PMCID: PMC9898860 DOI: 10.1007/s41347-023-00303-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/14/2022] [Accepted: 01/17/2023] [Indexed: 02/07/2023]
Abstract
COVID-19 forced college administrators to reassess how they provide students with the most effective methods of support. This project examined the first year of a novel digital peer mentoring program with the goal of connecting diverse students to campus resources they needed to navigate the transition to and through their first year of college. MentorHub, a referral and supportive accountability mobile application, was implemented with first-year undergraduates at a large, private university in the northeastern region of the USA. MentorHub tracked students' current challenges and connected them with trained peer mentors who provided students with support and referrals to campus resources (e.g., mental health, financial, academic). Analyses were not hypothesis-driven, but instead were exploratory and intended for improving the platform. In the first year of the program (August 2021 to June 2022), 47% (N = 3141) students logged onto the platform at least once. Patterns of self-reported challenges revealed that career concerns were the most challenging at the beginning of the fall semester, and that academic habits were most challenging over the course of the year. Referrals (N = 756) were made by mentors, 13% of which were for health and well-being. First-generation and underrepresented minority students showed distinct patterns in referrals. Findings revealed distinct patterns in self-reported challenges across the academic year. Students' use of MentorHub and responses to in-app questions allowed for a real-time understanding of student challenges and patterns of engagement with peer mentors. Implications for a stepped-care approach to addressing student challenges are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s41347-023-00303-8.
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Affiliation(s)
- Alexandra Werntz
- Center for Evidence-Based Mentoring, University of Massachusetts Boston, Boston, MA USA
| | - Megyn Jasman
- Center for Evidence-Based Mentoring, University of Massachusetts Boston, Boston, MA USA
| | | | | | | | - Jean E. Rhodes
- Center for Evidence-Based Mentoring, University of Massachusetts Boston, Boston, MA USA
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Tang Y, Gierc M, Lam RW, Liu S, Faulkner G. The Effectiveness of Internet-Guided Self-help Interventions to Promote Physical Activity Among Individuals With Depression: Systematic Review. JMIR Ment Health 2022; 9:e38049. [PMID: 36508243 PMCID: PMC9793299 DOI: 10.2196/38049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/01/2022] [Accepted: 11/13/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Depression is a prevalent and debilitating mental disorder and a leading cause of disability worldwide. Physical activity (PA) interventions have been shown to alleviate depressive symptoms. However, not all patients have access to PA programing tailored for depression. Internet-guided self-help (IGSH) interventions may be an effective option for increasing PA among people with depression who cannot or prefer not to access supervised exercise treatment. OBJECTIVE We aimed to evaluate the effectiveness of IGSH interventions in increasing PA and alleviating depressive symptoms in people with depression. METHODS A systematic literature search was conducted for randomized controlled trials and quasiexperimental studies using 9 electronic databases. The review was registered in PROSPERO (2020 CRD42020221713). RESULTS A total of 4 randomized controlled trials (430 participants) met the inclusion criteria. Of these, 3 were web-based and 1 was app-based. Three studies found IGSH interventions to have medium to large effects on decreasing depressive symptoms but not on increasing PA compared with waitlist or usual care. One study showed increased self-reported PA but no significant difference in depressive symptoms in the intervention group compared with the control group. Goal setting was the most common behavior change technique used in the interventions. Dropout rates within the intervention groups were relatively low (0%-19%). CONCLUSIONS Our findings suggested that IGSH PA interventions are feasible and have the potential to reduce depressive symptoms in people with depression. More well-designed and tailored interventions with different combinations of behavior change techniques, particularly those targeting the emotion domain, are needed to assess the overall effectiveness and feasibility of using IGSH interventions to increase PA among people with depression. TRIAL REGISTRATION PROSPERO CRD42020221713; https://tinyurl.com/ysaua5bu.
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Affiliation(s)
- Yiling Tang
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Madelaine Gierc
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Sam Liu
- School of Exercise Science, Physical & Health Education, University of Victoria, Vancouver, BC, Canada
| | - Guy Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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Stiles-Shields C, Reyes KM, Archer J, Lennan N, Zhang J, Julion WA, Karnik NS. mHealth Uses and Opportunities for Teens from Communities with High Health Disparities: A Mixed-Methods Study. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 8:1-13. [PMID: 36117748 PMCID: PMC9470238 DOI: 10.1007/s41347-022-00278-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/08/2022] [Accepted: 09/02/2022] [Indexed: 12/24/2022]
Abstract
Despite widespread access to smartphones, teens from communities facing significant behavioral health disparities typically have low mobile health (mHealth) engagement. The purpose of this study was to characterize teen and caregiver perspectives about smartphone use and access, mHealth, and how mHealth could address teens' behavioral health needs during the pandemic and beyond. Remote recruitment and methodologies were used to engage 17 teens (M age = 15.9 ± 0.9) and 10 caregivers living in urban communities with significant socioeconomic and health disparities. Participants completed a focus group or interview session (based on preference) and self-report questionnaires (e.g., behavioral health history, pandemic impacts, technology use). Qualitative and quantitative data were analyzed using thematic and descriptive analyses, respectively. Both quantitative and qualitative data indicated relevant behavioral health concerns for teens and their families, impacts from the pandemic, and frequent smartphone use. Primary teen and caregiver themes included (1) health and wellness concerns, (2) barriers, (3) use of smartphones, (4) impacts of smartphones, and (5) opinions/suggestions for mHealth. This multi-method and multi-informant study highlighted the lived experiences of teens from marginalized communities and offered key insights to increase the acceptability and real-world engagement of mHealth tools. To address barriers to care for this population beyond the pandemic, clear messaging must be used for mHealth tools (e.g., data privacy, expectations of use). These findings testify to the importance of collaboration with teens and caregivers from communities facing large health disparities in future mHealth design, development, and deployment.
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Affiliation(s)
- Colleen Stiles-Shields
- Rush University Medical Center, Chicago, IL USA
- Present Address: University of Illinois at Chicago, Chicago, IL USA
| | | | - Joseph Archer
- Present Address: University of Illinois at Chicago, Chicago, IL USA
| | - Nia Lennan
- Rush University Medical Center, Chicago, IL USA
| | - Jim Zhang
- Rosalind Franklin University of Medicine and Science, North Chicago, IL USA
| | | | - Niranjan S. Karnik
- Rush University Medical Center, Chicago, IL USA
- Present Address: University of Illinois at Chicago, Chicago, IL USA
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Patterson Silver Wolf DA, Ramsey AT, Epstein J, Beeler-Stinn S, Deer AAB. Bridges to Sobriety: Testing the Feasibility and Acceptability of a Mobile App Designed to Supplement an Adolescent Substance Use Disorder Treatment Program. CLINICAL SOCIAL WORK JOURNAL 2022; 50:308-315. [PMID: 36420447 PMCID: PMC9678348 DOI: 10.1007/s10615-020-00765-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Adolescent substance use is a growing problem that causes a myriad of negative outcomes. Using substances during adolescence can lead to decreased executive functioning and is correlated with the top three causes of deaths for adolescents. Treatment options vary and the impact on outcomes are mixed, with engagement being of the most important indicators. Gaming is a popular activity among adolescents, and yet smartphone applications are relatively unexplored within substance use disorder treatment programs. This paper explores the feasibility and acceptability of implementing a mobile application as a supplement to existing adolescent substance use disorder treatment in a behavioral health agency in eastern Missouri. Feedback was received from staff and clients to assess feasibility and acceptability of implementation with barriers discussed. Results indicate there is promise with incorporation of smartphone-based applications into existing interventions and act as recommendations for other providers.
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Affiliation(s)
| | - Alex T Ramsey
- Washington University in St. Louis, School of Medicine, St. Louis, MO, 63110, USA
| | - Joel Epstein
- University of Missouri St. Louis, Missouri Institute of Mental Health, St. Louis, MO 63134, USA
| | - Sara Beeler-Stinn
- Washington University in St. Louis, George Warren Brown School of Social Work, St. Louis, MO 63130, USA
| | - Autumn Asher Black Deer
- Washington University in St. Louis, George Warren Brown School of Social Work, St. Louis, MO 63130, USA
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Muñoz-Martínez AM, Otto-Scheiber CS, Zuluaga-Jassir S, Medina-Díaz A, Pulido-Rozo J, Venegas-Ramírez M, Igua-Jojoa A. Scalability of an ACT-Based strategy for improving well-being in health care providers: A mix-method and preliminary evaluation of efficacy. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022; 25:136-144. [PMID: 35966007 PMCID: PMC9359768 DOI: 10.1016/j.jcbs.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 02/01/2023]
Abstract
The burden of the COVID-19 pandemic has been mainly carried by health care providers. Technology-Mediated Interventions (TMI) seem to be a feasible alternative to increase access to behavioral health resources in this population. However, scaling-up treatments into TMI requires developing user-friendly, accepted, and accessible formats. A two-stage study was conducted to assess scalability of an Acceptance and Commitment Therapy (ACT) based strategy (named FACE COVID) delivered using technology. First, a mix-method design connected qualitative and quantitative data from health providers and ACT experts by which changes were performed to enhance scalability. Second, a pretest-posttest study was conducted to preliminary evaluate the efficacy of FACE COVID intervention on well-being, psychological distress, and psychological flexibility. Results showed a positive impact on well-being, but not distress and psychological flexibility. While this intervention has promising results, changes in dose intensity, social support, and mental health literacy could improve retention as well as increase opportunities to target distress and psychological flexibility in future studies.
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Chan AHY, Honey MLL. User perceptions of mobile digital apps for mental health: Acceptability and usability - An integrative review. J Psychiatr Ment Health Nurs 2022; 29:147-168. [PMID: 33604946 DOI: 10.1111/jpm.12744] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 01/16/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Mobile mental health apps are increasingly being used by both mental health nurses to promote individual self-managemental of mental health conditions and by consumers. Perceptions about specific apps are known, but the overarching acceptability and usability of mental health apps in general less understood. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper identified consumer perceptions of mobile mental health apps. Six key areas were identified that future mobile app developers should consider to maximize consumer engagement with mental health apps. Consumers also highlighted that apps do not replace traditional mental health nursing-rather these supplement existing care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This review found that mental health apps are generally viewed positively by consumers; however, factors such as ease of use, usefulness of content and privacy need to be considered to maximise and sustain app engagement. ABSTRACT: Introduction There is increasing interest in the use of mobile mental health applications (apps) to manage mental health conditions. Understanding user perceptions is key to maximise app engagement and inform how apps can be used to support mental health nursing care. Aim This integrative review explores consumers' perceptions of mobile mental health apps to gain insight into user preferences and acceptability. Methods This integrative review was based on searching four databases: CINAHL, EMBASE, Medline, PsycInfo. Inclusion criteria were: (i) articles published after 2000; (ii) focused on apps for mental health disorders; (iii) explored consumers' perception of using a mental health app. Abstracts were screened and eligible papers reviewed. Data on user perceptions were extracted and analysed thematically. Results Seventeen articles were identified. Overall, consumers did not feel that app use replaced traditional health care. Six themes were identified: "Helpfulness," "Improvements/enhancements," "Technical issues," "Easy to use," "Satisfaction with the app" and "Perceived issues." Consumers indicated a preference for personalization for the app to meet individual needs. Discussion and Implications for Practice Mental health apps are generally viewed positively by consumers; however, factors such as ease of use, usefulness of content and privacy need to be considered to maximise and sustain app engagement.
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Affiliation(s)
- Amy Hai Yan Chan
- School of Pharmacy, University of Auckland, Auckland, New Zealand
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13
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Hernández-Gómez A, Valdés-Florido MJ, Lahera G, Andrade-González N. Efficacy of Smartphone Apps in Patients With Depressive Disorders: A Systematic Review. Front Psychiatry 2022; 13:871966. [PMID: 36032248 PMCID: PMC9411805 DOI: 10.3389/fpsyt.2022.871966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital interventions have become an accessible format in clinical practice to provide better support for patients with mental disorders. However, the clinical efficacy in patients with depressive disorders is not well known. We aimed to determine the efficacy of smartphone applications (apps) in patients diagnosed with a depressive disorder. METHOD An electronic database search was performed of PubMed, PsycINFO, and Web of Science, to identify relevant articles up to June 12, 2021. Peer-reviewed articles were screened and selected based on predetermined inclusion and exclusion criteria. RESULTS Seven articles met the inclusion criteria and therefore were selected for the systematic review, which included a total of 651 patients. The results were heterogeneous, essentially due to the different methodologies used in the selected studies. CONCLUSIONS Digital smartphone-delivered interventions do not appear to reduce depressive symptomatology nor improve the quality of life in patients diagnosed with depressive disorders when compared to an active control group. Taking into account the inherent methodological difficulties and the variability among such studies, it is apparent that further research-with more methodologically refined clinical trials, including larger sample sizes-is needed.
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Affiliation(s)
- Alba Hernández-Gómez
- Department of Personality, Assessment and Clinical Psychology, Complutense University of Madrid, Madrid, Spain
| | - María José Valdés-Florido
- Psychiatry Service, University Hospital of Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Guillermo Lahera
- Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain.,IRyCIS, CIBERSAM, Madrid, Spain.,Príncipe de Asturias University Hospital, Alcalá de Henares, Spain
| | - Nelson Andrade-González
- Psychiatry and Mental Health Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain.,Faculty of Medicine, Alfonso X el Sabio University, Villanueva de la Cañada, Madrid, Spain
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14
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Nielsen P, Sahay S. A critical review of the role of technology and context in digital health research. Digit Health 2022; 8:20552076221109554. [PMID: 35769359 PMCID: PMC9234838 DOI: 10.1177/20552076221109554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 06/08/2022] [Indexed: 11/15/2022] Open
Abstract
Digital health represents a research field dedicated to realising digital
technologies’ potential and developing knowledge about their feasibility and
impacts. Yet, drawing on a critical review of the articles in the most prominent
multidisciplinary digital health journals, this paper argues that the digital
health field has not profoundly engaged with its core subject, namely
technology. The features of digital technologies remain in the background, and
research is disconnected from the complexities of healthcare settings, including
multiple technologies, established practices and people. Instead, the
overarching focus in the digital health literature is the processing
capabilities of digital technologies and their posited impacts. This paper
proposes a research direction in digital health where technology and the context
of use take a more prominent role. It argues that realising the potential of
digital health requires intensive investigation drawing on different
disciplines, grounded on understanding healthcare processes, related
informational needs and the concrete features of digital technologies.
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Affiliation(s)
- Petter Nielsen
- Department of Informatics, University of Oslo, Norway
- Petter Nielsen, Department of Informatics,
University of Oslo, Norway.
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, Norway
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15
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Nwaogu JM, Chan APC, Naslund JA, Hon CKH, Belonwu C, Yang J. Exploring the Barriers to and Motivators for Using Digital Mental Health Interventions Among Construction Personnel in Nigeria: Qualitative Study. JMIR Form Res 2021; 5:e18969. [PMID: 34751652 PMCID: PMC8663629 DOI: 10.2196/18969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/04/2021] [Accepted: 08/08/2021] [Indexed: 01/19/2023] Open
Abstract
Background Work-related stress in the construction industry increases the prevalence of depression and anxiety among personnel. In low-resource settings such as Nigeria, construction personnel face high demands and severe working conditions but only have a few services to address their mental health needs. With emerging research showing that digital interventions can be used to self-manage mental health across diverse settings, there may be new opportunities to support construction personnel in the construction industry. Objective This study aims to determine the use of digital interventions for mental health management among construction personnel in Nigeria and to explore the factors that facilitate or impede the use of these interventions. Methods This qualitative study explored the perspectives of a convenience sample of 62 construction personnel. The data were subjected to inductive content analysis. Results A total of 6 barrier and 3 motivator themes were identified and categorized into 2 groups. The barrier themes were subcategorized into barriers to adoption and barriers to persistent use, whereas the motivator themes were subcategorized into intrinsic and extrinsic motivators. Lack of awareness and knowledge about the interventions may constitute a barrier to adoption and use. Participants frequently reported concerns regarding their effectiveness and usability. Conclusions This study provides an understanding of the design needs required to facilitate sustained self-management of mental health based on the experiences and expectations of construction personnel with digital interventions.
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Affiliation(s)
- Janet Mayowa Nwaogu
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Albert P C Chan
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Carol K H Hon
- School of Civil Engineering and Built Environment, Queensland University of Technology, Queensland, Australia
| | | | - Jackie Yang
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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16
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Agnew JMR, Hanratty CE, McVeigh JG, Nugent C, Kerr DP. An investigation into the use of mHealth in musculoskeletal physiotherapy: Scoping Review (Preprint). JMIR Rehabil Assist Technol 2021; 9:e33609. [PMID: 35275089 PMCID: PMC8956993 DOI: 10.2196/33609] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/14/2021] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Musculoskeletal physiotherapy provides conservative management for a range of conditions. Currently, there is a lack of engagement with exercise programs because of the lack of supervision and low self-efficacy. The use of mobile health (mHealth) interventions could be a possible solution to this problem, helping promote self-management at home. However, there is little evidence for musculoskeletal physiotherapy on the most effective forms of mHealth. Objective The aim of this review is to investigate the literature focusing on the use of mHealth in musculoskeletal physiotherapy and summarize the evidence. Methods A scoping review of 6 peer-reviewed databases was conducted in March 2021. No date limits were applied, and only articles written in the English language were selected. A reviewer screened all the articles, followed by 2 additional researchers screening a random sample before data extraction. Results Of the 1393 studies, 28 (2.01%) were identified. Intervention characteristics comprised stretching and strengthening exercises, primarily for degenerative joint pain and spinal conditions (5/28, 18%). The most reported use of mHealth included telephone and videoconferencing calls to provide a home exercise program or being used as an adjunct to physiotherapy musculoskeletal assessment (14/28, 50%). Although patient satisfaction with mHealth was reported to be high, reasons for disengagement included a lack of high-quality information and poor internet speeds. Barriers to clinical uptake included insufficient training with the intervention and a lack of time to become familiar. Conclusions mHealth has some benefits regarding treatment adherence and can potentially be as effective as normal physiotherapy care while being more cost-effective. The current use of mHealth is most effective when ongoing feedback from a health care professional is available.
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Affiliation(s)
- Jonathon M R Agnew
- Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Newtownabbey, United Kingdom
| | - Catherine E Hanratty
- Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Newtownabbey, United Kingdom
| | - Joseph G McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Chris Nugent
- Discipline in Computing, School of Computing, University of Ulster, Newtownabbey, United Kingdom
| | - Daniel P Kerr
- Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Newtownabbey, United Kingdom
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17
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Giebel GD, Speckemeier C, Abels C, Börchers K, Wasem J, Blase N, Neusser S. Problems and Barriers related to the Use of Digital Health Applications: A Scoping Review Protocol (Preprint). JMIR Res Protoc 2021; 11:e32702. [PMID: 35451979 PMCID: PMC9073601 DOI: 10.2196/32702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/19/2021] [Accepted: 01/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background The use of mobile health (mHealth) apps is increasing rapidly worldwide. More and more institutions and organizations develop regulations and guidelines to enable an evidence-based and safe use. In Germany, mHealth apps fulfilling predefined criteria (Digitale Gesundheitsanwendungen [DiGA]) can be prescribed and are reimbursable by the German statutory health insurance scheme. Due to the increasing distribution of DiGA, problems and barriers should receive special attention. Objective This study aims to identify the relevant problems and barriers related to the use of mHealth apps fulfilling the criteria of DiGA. Methods This scoping review will follow published methodological frameworks and the PRISMA-Scr (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews) criteria. Electronic databases (MEDLINE, EMBASE, PsycINFO, and JMIR), reference lists of relevant articles, and grey literature sources will be searched. Two reviewers will assess the eligibility of the articles by a two-stage (title and abstract as well as full text) screening process. Only problems and barriers related to mHealth apps fulfilling the criteria of DiGA are included for this research. The identified studies will be categorized and analyzed with MAXQDA. Results This scoping review gives an overview of the available evidence and identifies research gaps regarding problems and barriers related to DiGA. The results are planned to be submitted to an indexed, peer-reviewed journal in the first quarter of 2022. Conclusions This is the first review to identify the problems and barriers related to the use of mHealth apps fulfilling the German definition of DiGA. Nevertheless, the findings can be applied to other contexts and health care systems as well. International Registered Report Identifier (IRRID) DERR1-10.2196/32702
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Affiliation(s)
- Godwin Denk Giebel
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Christian Speckemeier
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Carina Abels
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | | | - Jürgen Wasem
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Nikola Blase
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Silke Neusser
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
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18
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Eccles H, Nannarone M, Lashewicz B, Attridge M, Marchand A, Aiken A, Ho K, Wang J. Barriers to the Use of Web-Based Mental Health Programs for Preventing Depression: Qualitative Study. JMIR Form Res 2021; 5:e16949. [PMID: 34264195 PMCID: PMC8323021 DOI: 10.2196/16949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/09/2020] [Accepted: 05/19/2021] [Indexed: 01/19/2023] Open
Abstract
Background Depression has a profound impact on population health. Although using web-based mental health programs to prevent depression has been found to be effective in decreasing depression incidence, there are obstacles preventing their use, as reflected by the low rates of use and adherence. Objective The aims of the study are to understand the barriers to using web-based mental health programs for the prevention of depression and the possible dangers or concerns regarding the use of such programs. Methods BroMatters and HardHat were two randomized controlled trials (RCTs) that evaluated the effectiveness of e–mental health programs for preventing workplace depression. In the BroMatters RCT, only working men who were at high risk of having a major depressive episode were included. The participants were assigned to either the control group or 1 of 2 intervention groups. The control participants had access to the general depression information on the BroMatters website. Intervention group 1 had access to BroMatters and BroHealth—the depression prevention program. Intervention group 2 had access to BroMatters and BroHealth along with weekly access to a qualified coach through telephone calls. The HardHat trial targeted both men and women at high risk of having a major depressive episode. The participants in the intervention group were given access to the HardHat depression prevention program (which included a web-based coach), whereas HardHat access was only granted to the control group once the study was completed. This qualitative study recruited male participants from the intervention groups of the two RCTs. A total of 2 groups of participants were recruited from the BroMatters study (after a baseline interview: n=41; 1 month after the RCT: n=20; 61/744, 8.2%), and 1 group was recruited from the HardHat RCT 1 month after the initial quantitative interview (9/103, 8.7%). Semistructured interviews were performed with the participants (70/847, 8.3%) and analyzed using content analysis. Results There were both personal and program-level barriers to program use. The three personal barriers included time, stress level, and the perception of depression prevention. Content, functionality, and dangers were the program-level barriers to the use of web-based mental health programs. Large amounts of text and functionality issues within the programs decreased participants’ engagement. The dangers associated with web-based mental health programs included privacy breaches and inadequate help for severe symptoms. Conclusions There are personal and program-level barriers to the use of web-based mental health programs. The stigmatization of help seeking for depression symptoms affects the time spent on the program, as does the public perception of depression. Certain barriers may be mitigated by program updates, whereas others may require a complete shift in the perception of depression prevention.
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Affiliation(s)
- Heidi Eccles
- The Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Molly Nannarone
- The Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ON, Canada
| | - Mark Attridge
- Attridge Consulting, Inc, Minneapolis, MN, United States
| | - Alain Marchand
- School of Industrial Relations, University of Montreal, Montreal, QC, Canada.,Public Health Research Institute, University of Montreal, Montreal, QC, Canada
| | - Alice Aiken
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Kendall Ho
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - JianLi Wang
- The Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada.,Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China.,School of Epidemology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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19
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Patoz MC, Hidalgo-Mazzei D, Pereira B, Blanc O, de Chazeron I, Murru A, Verdolini N, Pacchiarotti I, Vieta E, Llorca PM, Samalin L. Patients' adherence to smartphone apps in the management of bipolar disorder: a systematic review. Int J Bipolar Disord 2021; 9:19. [PMID: 34081234 PMCID: PMC8175501 DOI: 10.1186/s40345-021-00224-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/01/2021] [Indexed: 02/07/2023] Open
Abstract
Background Despite an increasing number of available mental health apps in the bipolar disorder field, these tools remain scarcely implemented in everyday practice and are quickly discontinued by patients after downloading. The aim of this study is to explore adherence characteristics of bipolar disorder patients to dedicated smartphone interventions in research studies. Methods A systematic review following PRISMA guidelines was conducted. Three databases (EMBASE, PsychInfo and MEDLINE) were searched using the following keywords: "bipolar disorder" or "mood disorder" or “bipolar” combined with “digital” or “mobile” or “phone” or “smartphone” or “mHealth” or “ehealth” or "mobile health" or “app” or “mobile-health”. Results Thirteen articles remained in the review after exclusion criteria were applied. Of the 118 eligible studies, 39 did not provide adherence characteristics. Among the selected papers, study length, sample size and definition of measures of adherence were strongly heterogeneous. Activity rates ranged from 58 to 91.6%. Conclusion The adherence of bipolar patients to apps is understudied. Standardised measures of adherence should be defined and systematically evaluated in future studies dedicated to these tools. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-021-00224-6.
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Affiliation(s)
- Marie-Camille Patoz
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Diego Hidalgo-Mazzei
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Bruno Pereira
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Olivier Blanc
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Ingrid de Chazeron
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Andrea Murru
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Pierre-Michel Llorca
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France.,Fondation FondaMental, Créteil, France
| | - Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France. .,Fondation FondaMental, Créteil, France. .,Service de Psychiatrie B, Centre Hospitalier Universitaire, 58 rue Montalembert, 63000, Clermont-Ferrand, France.
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20
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Borghouts J, Eikey E, Mark G, De Leon C, Schueller SM, Schneider M, Stadnick N, Zheng K, Mukamel D, Sorkin DH. Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review. J Med Internet Res 2021; 23:e24387. [PMID: 33759801 PMCID: PMC8074985 DOI: 10.2196/24387] [Citation(s) in RCA: 219] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/24/2020] [Accepted: 02/08/2021] [Indexed: 01/14/2023] Open
Abstract
Background Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user’s uptake and sustained interactions with these interventions. Objective This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs. Methods A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included. Results A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health. Conclusions Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions.
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Affiliation(s)
| | - Elizabeth Eikey
- University of California San Diego, San Diego, CA, United States
| | - Gloria Mark
- University of California Irvine, Irvine, CA, United States
| | | | | | | | - Nicole Stadnick
- University of California San Diego, San Diego, CA, United States
| | - Kai Zheng
- University of California Irvine, Irvine, CA, United States
| | - Dana Mukamel
- University of California Irvine, Irvine, CA, United States
| | - Dara H Sorkin
- University of California Irvine, Irvine, CA, United States
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21
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Patoz MC, Hidalgo-Mazzei D, Blanc O, Verdolini N, Pacchiarotti I, Murru A, Zukerwar L, Vieta E, Llorca PM, Samalin L. Patient and physician perspectives of a smartphone application for depression: a qualitative study. BMC Psychiatry 2021; 21:65. [PMID: 33514333 PMCID: PMC7847000 DOI: 10.1186/s12888-021-03064-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/14/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite an increasing number of smartphone apps, such therapeutic tools have not yet consistently demonstrated their efficacy and many suffer from low retention rates. To ensure the development of efficient apps associated with high adherence, we aimed to identify, through a user-centred design approach, patient and physician expectations of a hypothetical app dedicated to depression. METHODS We conducted semi-structured interviews with physicians (psychiatrists and general practitioners) and patients who had experienced a major depressive episode during the last 12 months using the focus group method. The interviews were audio recorded, transcribed and analysed using qualitative content analysis to define codes, categories and emergent themes. RESULTS A total of 26 physicians and 24 patients were included in the study. The focus groups showed balanced sex and age distributions. Most participants owned a smartphone (83.3% of patients, 96.1% of physicians) and were app users (79.2% of patients and 96.1% of physicians). The qualitative content analysis revealed 3 main themes: content, operating characteristics and barriers to the use of the app. Expected content included the data collected by the app, aiming to provide information about the patient, data provided by the app, gathering psychoeducation elements, therapeutic tools and functionalities to help with the management of daily life and features expected for this tool. The "operating characteristics" theme gathered aims considered for the app, its potential target users, considered modalities of use and considerations around its accessibility and security of use. Finally, barriers to the use of the app included concerns about potential app users, its accessibility, safety, side-effects, utility and functioning. All themes and categories were the same for patients and physicians. CONCLUSIONS Physician and patient expectations of a hypothetical smartphone app dedicated to depression are high and confirmed the important role it could play in depression care. The key points expected by the users for such a tool are an easy and intuitive use and a personalised content. They are also waiting for an app that gives information about depression, offers a self-monitoring functionality and helps them in case of emergency.
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Affiliation(s)
- Marie-Camille Patoz
- grid.494717.80000000115480420Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia Spain
| | - Olivier Blanc
- grid.494717.80000000115480420Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France ,Fondation FondaMental, Hôpital Albert Chenevier, Pôle de Psychiatrie, Créteil, France
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia Spain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia Spain
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia Spain
| | | | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia Spain
| | - Pierre-Michel Llorca
- grid.494717.80000000115480420Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France ,Fondation FondaMental, Hôpital Albert Chenevier, Pôle de Psychiatrie, Créteil, France
| | - Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France. .,Fondation FondaMental, Hôpital Albert Chenevier, Pôle de Psychiatrie, Créteil, France.
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22
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Aboueid S, Meyer S, Wallace JR, Mahajan S, Chaurasia A. Young Adults' Perspectives on the Use of Symptom Checkers for Self-Triage and Self-Diagnosis: Qualitative Study. JMIR Public Health Surveill 2021; 7:e22637. [PMID: 33404515 PMCID: PMC7817365 DOI: 10.2196/22637] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/26/2020] [Accepted: 11/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Young adults often browse the internet for self-triage and diagnosis. More sophisticated digital platforms such as symptom checkers have recently become pervasive; however, little is known about their use. OBJECTIVE The aim of this study was to understand young adults' (18-34 years old) perspectives on the use of the Google search engine versus a symptom checker, as well as to identify the barriers and enablers for using a symptom checker for self-triage and self-diagnosis. METHODS A qualitative descriptive case study research design was used. Semistructured interviews were conducted with 24 young adults enrolled in a university in Ontario, Canada. All participants were given a clinical vignette and were asked to use a symptom checker (WebMD Symptom Checker or Babylon Health) while thinking out loud, and were asked questions regarding their experience. Interviews were audio-recorded, transcribed, and imported into the NVivo software program. Inductive thematic analysis was conducted independently by two researchers. RESULTS Using the Google search engine was perceived to be faster and more customizable (ie, ability to enter symptoms freely in the search engine) than a symptom checker; however, a symptom checker was perceived to be useful for a more personalized assessment. After having used a symptom checker, most of the participants believed that the platform needed improvement in the areas of accuracy, security and privacy, and medical jargon used. Given these limitations, most participants believed that symptom checkers could be more useful for self-triage than for self-diagnosis. Interestingly, more than half of the participants were not aware of symptom checkers prior to this study and most believed that this lack of awareness about the existence of symptom checkers hindered their use. CONCLUSIONS Awareness related to the existence of symptom checkers and their integration into the health care system are required to maximize benefits related to these platforms. Addressing the barriers identified in this study is likely to increase the acceptance and use of symptom checkers by young adults.
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Affiliation(s)
- Stephanie Aboueid
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Samantha Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - James R Wallace
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Shreya Mahajan
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Ashok Chaurasia
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Jiménez-Muñoz L, Gutiérrez-Rojas L, Porras-Segovia A, Courtet P, Baca-García E. Mobile applications for the management of chronic physical conditions: A systematic review. Intern Med J 2020; 52:21-29. [PMID: 33012045 DOI: 10.1111/imj.15081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/21/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic physical conditions (CPCs) decrease the quality of life of millions of people. In the absence of curative treatments, maintaining healthy lifestyle habits is one of the main pillars in their clinical management. Mobile-based interventions may help patients take care of their health and follow medical recommendations. The purpose of this review is to summarize the latest evidence about mobile phone applications (apps) for the management of CPC. METHODS We performed a systematic search of the PubMed and EMBASE databases to identify articles that explored apps for the management of CPCs, testing the apps empirically, and providing clear outputs on effectiveness and/or feasibility. 3528 articles were identified in the initial search. Following screening and selection process, 20 articles were finally included in the review. RESULTS Mobile apps for CPC are very heterogeneous. The condition with the greater number of apps available was diabetes, followed by cardiovascular diseases. Results of feasibility were generally positive, with high rates of study completion and user engagement. Some studies used incentives, monetary of otherwise. Some of the apps have been tested in randomized clinical trials showing effectiveness in improving symptoms and/or controlling analytical parameters. CONCLUSIONS Mobile apps are promising tools for the management of CPCs. Some apps have been sufficiently tested to propose their implementation in clinical practice. However, several barriers exist that can slow down the routine use of new technologies in healthcare settings. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Laura Jiménez-Muñoz
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain.,Department of Psychiatry, Jimenez Diaz Foundation Health Research Institute (IIS), Madrid, Spain.,Madrid Autonomous University, Madrid, Spain
| | | | - Alejandro Porras-Segovia
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain.,Department of Psychiatry, Jimenez Diaz Foundation Health Research Institute (IIS), Madrid, Spain
| | - Philippe Courtet
- University of Montpellier, France.,Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, Montpellier, France
| | - Enrique Baca-García
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain.,Department of Psychiatry, Jimenez Diaz Foundation Health Research Institute (IIS), Madrid, Spain.,Psychiatry Department, University of Granada, Spain.,CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain.,Universidad Católica del Maule, Talca, Chile.,Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain.,Department of Psychiatry, General Hospital of Villalba, Madrid, Spain.,Deparment of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain
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Porras-Segovia A, Molina-Madueño RM, Berrouiguet S, López-Castroman J, Barrigón ML, Pérez-Rodríguez MS, Marco JH, Díaz-Oliván I, de León S, Courtet P, Artés-Rodríguez A, Baca-García E. Smartphone-based ecological momentary assessment (EMA) in psychiatric patients and student controls: A real-world feasibility study. J Affect Disord 2020; 274:733-741. [PMID: 32664009 DOI: 10.1016/j.jad.2020.05.067] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Smartphone-based ecological momentary assessment (EMA) is a promising methodology for mental health research. The objective of this study is to determine the feasibility of smartphone-based active and passive EMA in psychiatric outpatients and student controls. METHODS Two smartphone applications -MEmind and eB2- were developed for behavioral active and passive monitoring. The applications were tested in psychiatric patients with a history of suicidal thoughts and/or behaviors (STB), psychiatric patients without a history of STB, and student controls. Main outcome was feasibility, measured as response to recruitment, retention, and EMA compliance. Secondary outcomes were patterns of smartphone usage. RESULTS Response rate was 87.3% in patients with a history of STB, 85.1% in patients without a history of STB, and 75.0% in student controls. 457 participants installed the MEmind app (120 patients with a history of STB and 337 controls) and 1,708 installed the eB2 app (139 patients with a history of STB, 1,224 patients with no history of STB and 346 controls). For the MEmind app, participants were followed-up for a median of 49.5, resulting in 22,622 person-days. For the eB2 application, participants were followed-up for a median of 48.9 days, resulting in 83,521 person-days. EMA compliance rate was 65.00% in suicidal patients and 75.21% in student controls. At the end of the follow-up, over 60% of participants remained in the study. LIMITATIONS Cases and controls were not matched by age and sex. Cases were patients who were receiving adequate psychopharmacological treatment and attending their appointments, which may result in an overstatement of clinical compliance. CONCLUSIONS Smartphone-based active and passive monitoring are feasible methods in psychiatric patients in real-world settings. The development of applications with friendly interfaces and directly useful features can help increase engagement without using incentives. The MEmind and eB2 applications are promising clinical tools that could contribute to the management of mental disorders. In the near future, these applications could serve as risk monitoring devices in the clinical practice.
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Affiliation(s)
- Alejandro Porras-Segovia
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain; Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid
| | | | - Sofian Berrouiguet
- Department of Psychiatry, Centre Hospitalier Universitaire De Brest, Brest, France
| | - Jorge López-Castroman
- Department of Psychiatric Emergency and Post-Acute Care, Hôpital Lapeyronie, Université de Montpellier, Montpellier, France; Department of Psychiatry, Centre Hospitalier Universitaire De Nîmes, Nîmes, France
| | - Maria Luisa Barrigón
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain; Universidad Autónoma de Madrid; Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - José Heliodoro Marco
- Departament of Personality, Assessment and Treatment, Universidad de Valencia, Valencia (Spain)
| | - Isaac Díaz-Oliván
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain; Universidad Autónoma de Madrid
| | - Santiago de León
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Philippe Courtet
- Department of Psychiatric Emergency and Post-Acute Care, Hôpital Lapeyronie, Université de Montpellier, Montpellier, France
| | - Antonio Artés-Rodríguez
- Department of Signal Theory, Universidad Carlos III de Madrid, Leganés, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Enrique Baca-García
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain; Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid.; Department of Psychiatry, Centre Hospitalier Universitaire De Nîmes, Nîmes, France; Universidad Autónoma de Madrid; Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Department of Psychiatry, Hospital Universitario Central de Villalba, Madrid.; Department of Psychiatry, Hospital Universitario Infanta Elena, Valdemoro, Madrid.; Universidad Católica del Maule, Talca, Chile; CIBERSAM (Centro de Investigación Biomédica en Red Salud Mental), Carlos III Institute of Health, Madrid, Spain.
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25
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Palmer KM, Burrows V. Ethical and Safety Concerns Regarding the Use of Mental Health-Related Apps in Counseling: Considerations for Counselors. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2020; 6:137-150. [PMID: 32904690 PMCID: PMC7457894 DOI: 10.1007/s41347-020-00160-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 08/04/2020] [Accepted: 08/13/2020] [Indexed: 12/23/2022]
Abstract
Mental health-related smartphone apps (MHapps) have the potential to greatly enhance and enrich the counseling relationship, and dramatically improve the lives of clients. However, a large portion of MHapps have not been empirically researched and found to be effective. An average of 2 million apps are available in the Apple and Android stores, and users average more than 80 apps on their phones. Many of the apps lack disclaimers about the collection of user information, and there is no governing body to oversee and regulate app development and availability. This is particularly problematic with mental health-related smartphone apps, because many developers are not affiliated with mental health professionals, and many apps do not provide emergency information should a mental health emergency occur while using the app. Moreover, users are left to haphazardly make decisions about health-related apps usage without assistance. Counselors who supplement counseling with mental health-related smartphone apps could unknowingly violate their Code of Ethics by integrating apps that may jeopardize their clients' safety. The authors review literature related to mental health-related app efficacy, safety, and ethics and provide a compilation of items to consider that can be used before supplementing counseling with mental health-related apps.
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Affiliation(s)
- Kathleen M. Palmer
- University of Detroit Mercy, 4001 W. McNichols Road, Detroit, MI 48221-3038 USA
| | - Vanessa Burrows
- University of Detroit Mercy, 4001 W. McNichols Road, Detroit, MI 48221-3038 USA
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26
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Stiles-Shields C, Potthoff LM, Bounds DT, Burns MTS, Draxler JM, Otwell CH, Wolodiger ED, Westrick J, Karnik NS. Harnessing Phones to Target Pediatric Populations with Socially Complex Needs: Systematic Review. JMIR Pediatr Parent 2020; 3:e19269. [PMID: 32845244 PMCID: PMC7481873 DOI: 10.2196/19269] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Mobile and smartphones are owned and accessed by many, making them a potentially optimal delivery mechanism to reach pediatric patients with socially complex needs (ie, pediatric populations who face overlapping adversities). OBJECTIVE To address the specialized needs of youth from such groups, this review synthesized the literature exploring the use of phone-based delivery to access pediatric populations with socially complex needs, targeting mental and behavioral health outcomes. The purpose of this synthesis was to provide recommendations for future research developing phone-based interventions for youth with socially complex needs. METHODS A trained medical librarian conducted the search strategy in the following databases: PubMed, Scopus, CINAHL, PsycINFO, Cochrane CENTRAL Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar. Studies targeting youth with socially complex needs were defined by recruiting samples that were primarily from traditionally underserved populations (ie, sex/gender minorities, racial/ethnic background, low socioeconomic status, rural/remote location, and sexual orientation). A systematic narrative framework was utilized and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed (registration number CRD42020141212). RESULTS A total of 14 studies met the inclusion criteria, with 3 depicting the use of phones to complete assessment and tracking goals and 11 to intervene on mental and behavioral health targets. CONCLUSIONS The literature indicates important directions for future research, including (1) involving diverse and representative teens (ie, the likely users of the interventions), stakeholders, and clinical/research staff; (2) integrating evidence-based therapies with minority-focused theories; (3) harnessing mobile device capabilities; and (4) considering and assessing for potential costs in phones as delivery mechanisms. TRIAL REGISTRATION PROSPERO CRD42020141212; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141212.
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Affiliation(s)
- Colleen Stiles-Shields
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Lauren M Potthoff
- Department of Gastroenterology, Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Dawn T Bounds
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, United States
| | | | - Janel M Draxler
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Caitlin H Otwell
- Autism Assessment, Research, Treatment & Services Center, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Emily D Wolodiger
- Autism Assessment, Research, Treatment & Services Center, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Jennifer Westrick
- Library of Rush University Medical Center, Chicago, IL, United States
| | - Niranjan S Karnik
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
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Eccles H, Nannarone M, Lashewicz B, Attridge M, Marchand A, Aiken A, Ho K, Wang J. Perceived Effectiveness and Motivations for the Use of Web-Based Mental Health Programs: Qualitative Study. J Med Internet Res 2020; 22:e16961. [PMID: 32735216 PMCID: PMC7428897 DOI: 10.2196/16961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/30/2020] [Accepted: 06/03/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The prevalence of depression is high and has been stable despite increased treatment, research, and dissemination. People encounter barriers to seeking traditional mental health services, which could be mitigated by using web-based prevention methods. OBJECTIVE This study aims to understand what people at high risk for depression perceive as effective aspects of web-based mental health programs and what motivates people at high risk for depression to use web-based mental health programs. METHODS We conducted an inductive content analysis using telephone interview data from 77 participants at high risk for depression who were recruited from 2 randomized controlled trials (RCTs). Participants from the first RCT were working men who had been randomly assigned to 1 of the following 3 groups: control group, who had access to general depression information from a website called BroMatters; intervention group 1, who had access to the BroMatters website along with the associated BroHealth web-based mental health program; and intervention group 2, who had access to the BroMatters website, the BroHealth web-based mental health program, and telephone sessions with a life coach. Participants from the second RCT were men and women who had been assigned to the intervention group, who received access to the HardHat web-based mental health program, or the control group, who only received access to the HardHat web-based mental health program following completion of the RCT. Participants for this inductive content analysis study were recruited from the intervention groups in both RCTs. Two groups of participants (n=41 and n=20) were recruited from the BroHealth RCT, and a third group comprised 16 participants that were recruited from the HardHat RCT. RESULTS We generated four categories regarding the perceived effectiveness of web-based programs and five categories related to what motivates the use of web-based programs. Participants identified awareness, program medium and functionality, program content, and coaches as categories related to the effectiveness of the programs. Categories of motivators to use web-based programs included providing reminders or incentives, promotion of the programs, providing appropriate medium and functionality, appropriate content, and perceived need. The final category related to motivators reflects perceptions of participants who were either unsure about what motivates them or believed that there is no way to motivate use. CONCLUSIONS Conflicting evidence was obtained regarding the perceived effectiveness of aspects of the content and functionality of web-based programs. In general, web-based mental health programs were perceived to help increase mental health awareness, especially when it includes live access to a coach. However, the results also revealed that it is difficult to motivate people to begin using web-based mental health programs. Strategies that may motivate the use of such programs include perceived personal need, effective promotion, providing incentives and reminders, and improving functionality.
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Affiliation(s)
- Heidi Eccles
- Work & Mental Health Research Unit, The Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Molly Nannarone
- Work & Mental Health Research Unit, The Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences,, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mark Attridge
- Attridge Consulting, Inc, Minneapolis, MN, United States
| | - Alain Marchand
- School of Industrial Relations, University of Montreal, Montreal, QC, Canada
- Public Health Research Institute, University of Montreal, Montreal, QC, Canada
| | - Alice Aiken
- Office of Research and Innovation, Dalhousie University, Halifax, NS, Canada
| | - Kendall Ho
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jianli Wang
- Work & Mental Health Research Unit, The Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
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Schueller SM, Steakley-Freeman DM, Mohr DC, Yom-Tov E. Understanding perceived barriers to treatment from web browsing behavior. J Affect Disord 2020; 267:63-66. [PMID: 32063574 DOI: 10.1016/j.jad.2020.01.131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 12/02/2019] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The expanding amount of information available from our use of technologies has led researchers to explore how this information can aid in the detection of mental health issues. We expand on past work in this area by exploring how browsing histories might be able to predict perceived barriers to psychological treatment. METHODS We obtained 10 days of browsing history data for 255 respondents as well as assessments of Perceived Barriers to Psychological Treatments and depression, the Patient Health Questionnaire. RESULTS We found that browsing histories enabled high performance classification of people with high levels of perceived barriers to psychological treatments (AUC average of 0.86). LIMITATIONS Our high classification accuracy does not help understand why different features within the browsing histories are useful to classify people according to browsing history. We also look at people who decided to contribute their browsing history but the use of this data more generally presents additional ethical questions. CONCLUSIONS Browsing histories might be useful to classify people's barriers to seeking psychological treatment. It is clinically relevant to find those who perceive barriers to seeking treatment to better design ways to address those concerns and help them find treatment.
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Affiliation(s)
- Stephen M Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA; Department of Preventive Medicine, Northwestern University, Chicago, IL, USA.
| | | | - David C Mohr
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
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29
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Lattie EG, Kornfield R, Ringland KE, Zhang R, Winquist N, Reddy M. Designing Mental Health Technologies that Support the Social Ecosystem of College Students. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2020; 2020:10.1145/3313831.3376362. [PMID: 32656549 PMCID: PMC7351354 DOI: 10.1145/3313831.3376362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The last decade has seen increased reports of mental health problems among college students, with college counseling centers struggling to keep up with the demand for services. Digital mental health tools offer a potential solution to expand the reach of mental health services for college students. In this paper, we present findings from a series of design activities conducted with college students and counseling center staff aimed at identifying needs and preferences for digital mental health tools. Results emphasize the social ecosystems and social support networks in a college student's life. Our findings highlight the predominant role of known peers, and the ancillary roles of unknown peers and non-peers (e.g., faculty, family) in influencing the types of digital mental health tools students desire, and the ways in which they want to learn about mental health tools. We identify considerations for designing digital mental health tools for college students that take into account the identified social factors and roles.
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Affiliation(s)
- Emily G Lattie
- Medical Social Sciences, Northwestern University, Evanston, IL, United States
| | - Rachel Kornfield
- Communication Studies, Northwestern University, Evanston, IL, United States
| | - Kathryn E Ringland
- Communication Studies, Northwestern University, Evanston, IL, United States
| | - Renwen Zhang
- Communication Studies, Northwestern University, Evanston, IL, United States
| | - Nathan Winquist
- Preventive Medicine, Northwestern University, Evanston, IL, United States
| | - Madhu Reddy
- Communication Studies, Northwestern University, Evanston, IL, United States
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Porras-Segovia A, Díaz-Oliván I, Gutiérrez-Rojas L, Dunne H, Moreno M, Baca-García E. Apps for Depression: Are They Ready to Work? Curr Psychiatry Rep 2020; 22:11. [PMID: 32025826 DOI: 10.1007/s11920-020-1134-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To summarize the latest evidence about mobile phone applications for the management of depression. RECENT FINDINGS Depression apps are very heterogeneous, given the absence of standards for their development, description, and evaluation. Randomized clinical trials show the effectiveness of some of these applications in reducing depressive symptoms. Attrition is an important issue whose evaluation is limited by the frequent use of incentives in the studies. The number of mobile applications for depression far exceeds the number of studies evaluating their efficacy and feasibility. Despite the limitations of the digital market, there are a small number of apps that have demonstrated sufficient effectiveness and tolerability to think of short-term clinical use. However, there are still barriers at different levels that may delay the implementation of these interventions in daily clinical practice.
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Affiliation(s)
- Alejandro Porras-Segovia
- Department of Psychiatry, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain. .,Department of Psychiatry, Hospital Rey Juan Carlos, Móstoles, Spain.
| | - Isaac Díaz-Oliván
- Department of Psychiatry, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.,Department of Psychiatry, Hospital Rey Juan Carlos, Móstoles, Spain.,Madrid Autonomous University, Madrid, Spain
| | - Luis Gutiérrez-Rojas
- Department of Psychiatry, Universidad de Granada, Granada, Spain.,Unidad de Hospitalización del Hospital Campus de la Salud, Complejo Hospitalario de Granada, Granada, Spain
| | - Henry Dunne
- Brighton & Sussex University Hospital, Brighton, UK
| | - Manon Moreno
- Department of Psychiatry, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.,Department of Psychiatry, Hospital Rey Juan Carlos, Móstoles, Spain
| | - Enrique Baca-García
- Department of Psychiatry, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.,Department of Psychiatry, Hospital Rey Juan Carlos, Móstoles, Spain.,Madrid Autonomous University, Madrid, Spain.,CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain.,Universidad Catolica del Maule, Talca, Chile.,Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,Department of Psychiatry, General Hospital of Villalba, Madrid, Spain.,Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain
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31
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Stiles-Shields C, Anderson L, Driscoll CFB, Ohanian DM, Starnes M, Stern A, Yunez J, Holmbeck GN. Technology usage and barriers to the use of behavioral intervention technologies in adolescents and young adults with spina bifida. J Pediatr Rehabil Med 2020; 13:675-683. [PMID: 32986627 DOI: 10.3233/prm-190652] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The majority of behavioral intervention technologies (BITs) have been designed and targeted towards the general population (i.e., typically-developing individuals); thus, little is known about the use of BITs to aid those with special needs, such as youth with disabilities. The current study assessed adolescents and young adults with spina bifida (AYA-SB) for: 1) their technology usage, and 2) anticipated barriers to using technology to help manage their health. METHODS AYA-SB completed a survey of their media and technology usage. A card sorting task that ranked and grouped anticipated barriers to using a mobile app to manage health was also completed. Ranked means, standard deviations, and the number of times a barrier was discarded were used to interpret sample rankings. RESULTS AYA-SB reported less frequent technology and media use than the general population. However, differences emerged by age, with young adults endorsing higher usage than their younger counterparts. Top concerns focused on usability, accessibility, safety, personal barriers due to lack of engagement, technological functioning, privacy, and efficacy. CONCLUSIONS AYA-SB appear to be selective users of technology. It is therefore critical that the design of BITs address their concerns, specifically aiming to have high usability, accessibility, and engagement.
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Affiliation(s)
- Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Section of Community Behavioral Health, Rush University Medical Center, Chicago, IL, USA
| | - Lara Anderson
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | | | - Diana M Ohanian
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Meredith Starnes
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Alexa Stern
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Jessica Yunez
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
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Schmidlen T, Schwartz M, DiLoreto K, Kirchner HL, Sturm AC. Patient assessment of chatbots for the scalable delivery of genetic counseling. J Genet Couns 2019; 28:1166-1177. [PMID: 31549758 DOI: 10.1002/jgc4.1169] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/22/2019] [Accepted: 08/25/2019] [Indexed: 11/09/2022]
Abstract
A barrier to incorporating genomics more broadly is limited access to providers with genomics expertise. Chatbots are a technology-based simulated conversation used in scaling communications. Geisinger and Clear Genetics, Inc. have developed chatbots to facilitate communication with participants receiving clinically actionable genetic variants from the MyCode® Community Health Initiative (MyCode® ). The consent chatbot walks patients through the consent allowing them to opt to receive more or less detail on key topics (goals, benefits, risks, etc.). The follow-up chatbot reminds participants of suggested actions following result receipt and the cascade chatbot can be sent to at-risk relatives by participants to share their genetic test results and facilitate cascade testing. To explore the acceptability, usability, and understanding of the study consent, post-result follow-up and cascade testing chatbots, we conducted six focus groups with MyCode® participants. Sixty-two individuals participated in a focus group (n = 33 consent chatbot, n = 29 follow-up and cascade chatbot). Participants were mostly female (n = 42, 68%), Caucasian (n = 58, 94%), college-educated (n = 33,53%), retirees (n = 38, 61%), and of age 56 years or older (n = 52, 84%). Few participants reported that they knew what a chatbot was (n = 10, 16%), and a small number reported that they had used a chatbot (n = 5, 8%). Qualitative analysis of transcripts and notes from focus groups revealed four main themes: (a) overall impressions, (b) suggested improvements, (c) concerns and limitations, and (d) implementation. Participants supported using chatbots to consent for genomics research and to interact with healthcare providers for care coordination following receipt of genomic results. Most expressed willingness to use a chatbot to share genetic information with relatives. The consent chatbot presents an engaging alternative to deliver content challenging to comprehend in traditional paper or in-person consent. The cascade and follow-up chatbots may be acceptable, user-friendly, scalable approaches to manage ancillary genetic counseling tasks.
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Affiliation(s)
- Tara Schmidlen
- Geisinger, Genomic Medicine Institute, Danville, PA, USA
| | - Marci Schwartz
- Geisinger, Genomic Medicine Institute, Danville, PA, USA
| | - Kristy DiLoreto
- The Pennsylvania State University, College of Health and Human Development, University Park, PA, USA
| | | | - Amy C Sturm
- Geisinger, Genomic Medicine Institute, Danville, PA, USA
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Adu MD, Malabu UH, Malau-Aduli AEO, Malau-Aduli BS. Mobile application intervention to promote self-management in insulin-requiring type 1 and type 2 diabetes individuals: protocol for a mixed methods study and non-blinded randomized controlled trial. Diabetes Metab Syndr Obes 2019; 12:789-800. [PMID: 31213866 PMCID: PMC6538012 DOI: 10.2147/dmso.s208324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/29/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Mobile applications (apps) have proven to be useful in supporting diabetes self-care, but non-consideration of users' needs and non-inclusion of educational features are reasons for low continual use. Well-designed mobile apps that meet the needs of diabetes patients and provide ongoing self-management education and support are required. It was hypothesized that apps designed with such features can improve a range of measures including clinical outcomes, knowledge of diabetes, medication adherence, perceived ability for self-management, and quality-of-life. This may eventually facilitate a more robust and cost-effective approach for improving skills and motivation for the management of diabetes. Methods: This project will be conducted in two phases. It will initially employ a mixed methods study design to investigate the self-management needs and perceptions of diabetes patients on the use of mobile apps to support diabetes self-management. Results of the mixed methods study will inform the content and design of an app which will be employed as an intervention tool in a 12-month parallel randomized controlled trial (RCT). The RCT will compare outcomes in relation to standard-of-care alone with standard-of-care plus a mobile phone diabetes app among 150 insulin-requiring types 1 and 2 diabetes patients. The primary outcome measures are clinical parameters such as hemoglobin A1c (HbA1c), lipids, urine albumin-to-creatinine ratio, blood pressure, frequency in events of emergency hyperglycemia and hypoglycemia. Secondary outcomes include knowledge of diabetes, medication intake and adherence, perception of self-care, and quality-of-life. Discussion: Results from this study will provide empirical evidence on the usefulness of a mobile app developed based on self-management needs analysis of diabetic patients. The long-term goal is to harness knowledge gained from this study to provide evidenced-based data, which promote the scale-up or adoption of mobile applications that provide regular, ongoing education and self-management support to people living with diabetes. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12618000065291, Registered on 17 January, 2018 (prospectively registered).
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Affiliation(s)
- Mary D Adu
- College of Medicine and Dentistry, James Cook University, Townsville, QLD4811, Australia
| | - Usman H Malabu
- College of Medicine and Dentistry, James Cook University, Townsville, QLD4811, Australia
| | - Aduli EO Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD4811, Australia
| | - Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD4811, Australia
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Lipschitz J, Miller CJ, Hogan TP, Burdick KE, Lippin-Foster R, Simon SR, Burgess J. Adoption of Mobile Apps for Depression and Anxiety: Cross-Sectional Survey Study on Patient Interest and Barriers to Engagement. JMIR Ment Health 2019; 6:e11334. [PMID: 30681968 PMCID: PMC6367667 DOI: 10.2196/11334] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/21/2018] [Accepted: 09/08/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Emerging research suggests that mobile apps can be used to effectively treat common mental illnesses like depression and anxiety. Despite promising efficacy results and ease of access to these interventions, adoption of mobile health (mHealth; mobile device-delivered) interventions for mental illness has been limited. More insight into patients' perspectives on mHealth interventions is required to create effective implementation strategies and to adapt existing interventions to facilitate higher rates of adoption. OBJECTIVE The aim of this study was to examine, from the patient perspective, current use and factors that may impact the use of mHealth interventions for mental illness. METHODS This was a cross-sectional survey study of veterans who had attended an appointment at a single Veterans Health Administration facility in early 2016 that was associated with one of the following mental health concerns: unipolar depression, any anxiety disorder, or posttraumatic stress disorder. We used the Veteran Affairs Corporate Data Warehouse to create subsets of eligible participants demographically stratified by gender (male or female) and minority status (white or nonwhite). From each subset, 100 participants were selected at random and mailed a paper survey with items addressing the demographics, overall health, mental health, technology ownership or use, interest in mobile app interventions for mental illness, reasons for use or nonuse, and interest in specific features of mobile apps for mental illness. RESULTS Of the 400 potential participants, 149 (37.3%, 149/400) completed and returned a survey. Most participants (79.9%, 119/149) reported that they owned a smart device and that they use apps in general (71.1%, 106/149). Most participants (73.1%, 87/149) reported interest in using an app for mental illness, but only 10.7% (16/149) had done so. Paired samples t tests indicated that ratings of interest in using an app recommended by a clinician were significantly greater than general interest ratings and even greater when the recommending clinician was a specialty mental health provider. The most frequent concerns related to using an app for mental illness were lacking proof of efficacy (71.8%, 107/149), concerns about data privacy (59.1%, 88/149), and not knowing where to find such an app (51.0%, 76/149). Participants expressed interest in a number of app features with particularly high-interest ratings for context-sensitive apps (85.2%, 127/149), and apps focused on the following areas: increasing exercise (75.8%, 113/149), improving sleep (73.2%, 109/149), changing negative thinking (70.5%, 105/149), and increasing involvement in activities (67.1%, 100/149). CONCLUSIONS Most respondents had access to devices to use mobile apps for mental illness, already used apps for other purposes, and were interested in mobile apps for mental illness. Key factors that may improve adoption include provider endorsement, greater publicity of efficacious apps, and clear messaging about efficacy and privacy of information. Finally, multifaceted apps that address a range of concerns, from sleep to negative thought patterns, may be best received.
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Affiliation(s)
- Jessica Lipschitz
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Christopher J Miller
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Rachel Lippin-Foster
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States
| | - Steven R Simon
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States.,Geriatrics and Extended Care Service, Veterans Affairs Boston Healthcare System, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - James Burgess
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States
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Stiles-Shields C, Montague E, Lattie EG, Schueller SM, Kwasny MJ, Mohr DC. Exploring User Learnability and Learning Performance in an App for Depression: Usability Study. JMIR Hum Factors 2017; 4:e18. [PMID: 28801301 PMCID: PMC5573426 DOI: 10.2196/humanfactors.7951] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/12/2017] [Accepted: 06/12/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Mental health apps tend to be narrow in their functioning, with their focus mostly being on tracking, management, or psychoeducation. It is unclear what capability such apps have to facilitate a change in users, particularly in terms of learning key constructs relating to behavioral interventions. Thought Challenger (CBITs, Chicago) is a skill-building app that engages users in cognitive restructuring, a core component of cognitive therapy (CT) for depression. OBJECTIVE The purpose of this study was to evaluate the learnability and learning performance of users following initial use of Thought Challenger. METHODS Twenty adults completed in-lab usability testing of Thought Challenger, which comprised two interactions with the app. Learnability was measured via completion times, error rates, and psychologist ratings of user entries in the app; learning performance was measured via a test of CT knowledge and skills. Nonparametric tests were conducted to evaluate the difference between individuals with no or mild depression to those with moderate to severe depression, as well as differences in completion times and pre- and posttests. RESULTS Across the two interactions, the majority of completion times were found to be acceptable (5 min or less), with minimal errors (1.2%, 10/840) and successful completion of CT thought records. Furthermore, CT knowledge and skills significantly improved after the initial use of Thought Challenger (P=.009). CONCLUSIONS The learning objectives for Thought Challenger during initial uses were successfully met in an evaluation with likely end users. The findings therefore suggest that apps are capable of providing users with opportunities for learning of intervention skills.
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Affiliation(s)
- Colleen Stiles-Shields
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL, United States
| | - Enid Montague
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,College of Computing, DePaul University, Chicago, IL, United States
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Stephen M Schueller
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Mary J Kwasny
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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