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Adler RF, Baez K, Morales P, Sotelo J, Victorson D, Magasi S. Evaluating the Usability of an mHealth App for Empowering Cancer Survivors With Disabilities: Heuristic Evaluation and Usability Testing. JMIR Hum Factors 2024; 11:e51522. [PMID: 38564261 PMCID: PMC11022134 DOI: 10.2196/51522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND More than 18 million cancer survivors are living in the United States. The effects of cancer and its treatments can have cognitive, psychological, physical, and social consequences that many survivors find incredibly disabling. Posttreatment support is often unavailable or underused, especially for survivors living with disabilities. This leaves them to deal with new obstacles and struggles on their own, oftentimes feeling lost during this transition. Mobile health (mHealth) interventions have been shown to effectively aid cancer survivors in dealing with many of the aftereffects of cancer and its treatments; these interventions hold immense potential for survivors living with disabilities. We developed a prototype for WeCanManage, an mHealth-delivered self-management intervention to empower cancer survivors living with disabilities through problem-solving, mindfulness, and self-advocacy training. OBJECTIVE Our study conducted a heuristic evaluation of the WeCanManage high-fidelity prototype and assessed its usability among cancer survivors with known disabilities. METHODS We evaluated the prototype using Nielsen's 10 principles of heuristic evaluation with 22 human-computer interaction university students. On the basis of the heuristic evaluation findings, we modified the prototype and conducted usability testing on 10 cancer survivors with a variety of known disabilities, examining effectiveness, efficiency, usability, and satisfaction, including a completion of the modified System Usability Scale (SUS). RESULTS The findings from the heuristic evaluation were mostly favorable, highlighting the need for a help guide, addressing accessibility concerns, and enhancing the navigation experience. After usability testing, the average SUS score was 81, indicating a good-excellent design. The participants in the usability testing sample expressed positive reactions toward the app's design, educational content and videos, and the available means of connecting with others. They identified areas for improvement, such as improving accessibility, simplifying navigation within the community forums, and providing a more convenient method to access the help guide. CONCLUSIONS Overall, usability testing showed positive results for the design of WeCanManage. The course content and features helped participants feel heard, understood, and less alone.
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Affiliation(s)
- Rachel F Adler
- Department of Computer Science, Northeastern Illinois University, Chicago, IL, United States
- School of Information Sciences, University of Illinois Urbana-Champaign, Champaign, IL, United States
| | - Kevin Baez
- Department of Computer Science, Northeastern Illinois University, Chicago, IL, United States
| | - Paulina Morales
- Department of Computer Science, Northeastern Illinois University, Chicago, IL, United States
| | - Jocelyn Sotelo
- Department of Computer Science, Northeastern Illinois University, Chicago, IL, United States
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University, Evanston, IL, United States
| | - Susan Magasi
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, United States
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Ibarra-Noriega AM, Yansane A, Mullins J, Simmons K, Skourtes N, Holmes D, White J, Kalenderian E, Walji MF. Evaluating and improving the usability of a mHealth platform to assess postoperative dental pain. JAMIA Open 2024; 7:ooae018. [PMID: 38476372 PMCID: PMC10928307 DOI: 10.1093/jamiaopen/ooae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Objectives The use of interactive mobile health (mHealth) applications to monitor patient-reported postoperative pain outcomes is an emerging area in dentistry that requires further exploration. This study aimed to evaluate and improve the usability of an existing mHealth application. Materials and methods The usability of the application was assessed iteratively using a 3-phase approach, including a rapid cognitive walkthrough (Phase I), lab-based usability testing (Phase II), and in situ pilot testing (Phase III). The study team conducted Phase I, while providers and patients participated in Phase II and III. Results The rapid cognitive walkthrough identified 23 potential issues that could negatively impact user experience, with the majority classified as system issues. The lab-based usability testing yielded 141 usability issues.; 43% encountered by patients and 57% by dentists. Usability problems encountered during pilot testing included undelivered messages due to mobile phone carrier and service-related issues, errors in patients' phone number data entry, and problems in provider training. Discussion Through collaborative and iterative work with the vendor, usability issues were addressed before launching a trial to assess its efficacy. Conclusion The usability of the mHealth application for postoperative dental pain was remarkably improved by the iterative analysis and interdisciplinary collaboration.
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Affiliation(s)
- Ana M Ibarra-Noriega
- Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX 77054, United States
| | - Alfa Yansane
- Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA 94143, United States
| | | | | | | | | | - Joel White
- Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA 94143, United States
| | - Elsbeth Kalenderian
- Marquette University School of Dentistry, Milwaukee, WI 53233, United States
- Department of Dental Management, School of Dentistry, University of Pretoria, Pretoria, 0002, South Africa
| | - Muhammad F Walji
- Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX 77054, United States
- Department of Clinical and Health Informatics, UTHealth Houston McWilliams School of Biomedical Informatics, Houston, TX 77030, United States
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Haime Z, Kennedy L, Grace L, Cohen R, Derges J, Biddle L. The Journey of Engaging With Web-Based Self-Harm and Suicide Content: Longitudinal Qualitative Study. JMIR INFODEMIOLOGY 2024; 4:e47699. [PMID: 38546718 PMCID: PMC11009851 DOI: 10.2196/47699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/10/2023] [Accepted: 02/15/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Self-harm and suicide are major public health concerns worldwide, with attention focused on the web environment as a helpful or harmful influence. Longitudinal research on self-harm and suicide-related internet use is limited, highlighting a paucity of evidence on long-term patterns and effects of engaging with such content. OBJECTIVE This study explores the experiences of people engaging with self-harm or suicide content over a 6-month period. METHODS This study used qualitative and digital ethnographic methods longitudinally, including one-to-one interviews at 3 time points to explore individual narratives. A trajectory analysis approach involving 4 steps was used to interpret the data. RESULTS The findings from 14 participants established the web-based journey of people who engage with self-harm or suicide content. In total, 5 themes were identified: initial interactions with self-harm or suicide content, changes in what self-harm or suicide content people engage with and where, changes in experiences of self-harm or suicide behaviors associated with web-based self-harm or suicide content engagement, the disengagement-reengagement cycle, and future perspectives on web-based self-harm or suicide content engagement. Initial engagements were driven by participants seeking help, often when offline support had been unavailable. Some participants' exposure to self-harm and suicide content led to their own self-harm and suicide behaviors, with varying patterns of change over time. Notably, disengagement from web-based self-harm and suicide spaces served as a protective measure for all participants, but the pull of familiar content resulted in only brief periods of disconnection. Participants also expressed future intentions to continue returning to these self-harm and suicide web-based spaces, acknowledging the nonlinear nature of their own recovery journey and aiming to support others in the community. Within the themes identified in this study, narratives revealed that participants' behavior was shaped by cognitive flexibility and rigidity, metacognitive abilities, and digital expertise. Opportunities for behavior change arose during periods of cognitive flexibility prompted by life events, stressors, and shifts in mental health. Participants sought diverse and potentially harmful content during challenging times but moved toward recovery-oriented engagements in positive circumstances. Metacognitive and digital efficacy skills also played a pivotal role in participants' control of web-based interactions, enabling more effective management of content or platforms or sites that posed potential harms. CONCLUSIONS This study demonstrated the complexity of web-based interactions, with beneficial and harmful content intertwined. Participants who demonstrated metacognition and digital efficacy had better control over web-based engagements. Some attributed these skills to study processes, including taking part in reflective diaries, showing the potential of upskilling users. This study also highlighted how participants remained vulnerable by engaging with familiar web-based spaces, emphasizing the responsibility of web-based industry leaders to develop tools that empower users to enhance their web-based safety.
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Affiliation(s)
- Zoë Haime
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Laura Kennedy
- Centre for Society and Mental Health, Kings College, London, United Kingdom
- Samaritans, Surrey, United Kingdom
- Department of Health Service and Population Research, King's College London, London, United Kingdom
| | | | - Rachel Cohen
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Health and Social Services Group, Welsh Government, Cardiff, United Kingdom
| | - Jane Derges
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lucy Biddle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Brotherdale R, Berry K, Branitsky A, Bucci S. Co-producing digital mental health interventions: A systematic review. Digit Health 2024; 10:20552076241239172. [PMID: 38665886 PMCID: PMC11044797 DOI: 10.1177/20552076241239172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/28/2024] Open
Abstract
Objective Smartphone apps (apps) are widely recognised as promising tools for improving access to mental healthcare. However, a key challenge is the development of digital interventions that are acceptable to end users. Co-production with providers and stakeholders is increasingly positioned as the gold standard for improving uptake, engagement, and healthcare outcomes. Nevertheless, clear guidance around the process of co-production is lacking. The objectives of this review were to: (i) present an overview of the methods and approaches to co-production when designing, producing, and evaluating digital mental health interventions; and (ii) explore the barriers and facilitators affecting co-production in this context. Methods A pre-registered (CRD42023414007) systematic review was completed in accordance with The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Five databases were searched. A co-produced bespoke quality appraisal tool was developed with an expert by experience to assess the quality of the co-production methods and approaches. A narrative synthesis was conducted. Results Twenty-six studies across 24 digital mental health interventions met inclusion criteria. App interventions were rarely co-produced with end users throughout all stages of design, development, and evaluation. Co-producing digital mental health interventions added value by creating culturally sensitive and acceptable interventions. Reported challenges included resource issues exacerbated by the digital nature of the intervention, variability across stakeholder suggestions, and power imbalances between stakeholders and researchers. Conclusions Variation in approaches to co-producing digital mental health interventions is evident, with inconsistencies between stakeholder groups involved, stage of involvement, stakeholders' roles and methods employed.
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Affiliation(s)
- Rebecca Brotherdale
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Katherine Berry
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison Branitsky
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Veldmeijer L, Terlouw G, Van Os J, Van Dijk O, Van 't Veer J, Boonstra N. The Involvement of Service Users and People With Lived Experience in Mental Health Care Innovation Through Design: Systematic Review. JMIR Ment Health 2023; 10:e46590. [PMID: 37490326 PMCID: PMC10410372 DOI: 10.2196/46590] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/10/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Mental health care faces challenges that not only necessitate innovation but also require the involvement of service users and people with lived experience in developing and evaluating mental health care services. As the development of digital interventions is becoming more prevalent, design approaches are increasingly finding their way into mental health. There is evidence that these approaches can successfully integrate user experience into mental health services. However, there is no clear overview of the studies conducted and the lessons learned concerning the involvement of service users and people with lived experience. OBJECTIVE In this systematic review, we aimed to provide an overview of the involvement of service users and people with lived experience in mental health care services through design approaches and to synthesize the advantages of design approaches in mental health care. METHODS The following 5 databases were searched for relevant abstracts: PsycINFO, PubMed, Web of Science, Scopus, and Embase. In addition, 2 health design journal archives, Design for Health and The Journal of Health Design, were searched. To categorize the results, we collected the reported added value from the included articles and conducted a thematic synthesis in which the themes were developed from the retrieved data. The themes were discussed, revised, and checked until saturation was achieved. RESULTS We included and categorized 33 papers. Most studies involved service users, primarily adults, and used various design approaches. Most of these studies aimed to design or evaluate digital interventions. Service users and people with lived experience were involved in different roles but never as decision makers. Studies that used co-design approaches exhibited the highest levels of involvement. Various added values were reported, including tailoring and testing interventions and digital interventions, improving engagement and collaboration, gathering the needs of stakeholders, and empowering participants as resourceful actors. The challenges reported were maintaining participants' continued participation throughout the study, managing the iterative nature of design, providing a safe space, balancing insights from design and medical science, and navigating design processes in medical environments. CONCLUSIONS This systematic review provides an overview of the studies that used design approaches to involve service users and people with lived experience in mental health care innovation. Design approaches have advantages in mental health care innovation, offering added value and having manageable challenges. Future studies using design approaches in mental health care should involve participants as partners and decision makers and report on collaboration in a systematic and clear manner.
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Affiliation(s)
- Lars Veldmeijer
- Department of Psychiatry, Utrecht University Medical Center, Utrecht, Netherlands
- Department of Healthcare and Welfare, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
| | - Gijs Terlouw
- Department of Healthcare and Welfare, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
| | - Jim Van Os
- Department of Psychiatry, Utrecht University Medical Center, Utrecht, Netherlands
| | - Olga Van Dijk
- NHL Stenden Library, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
| | - Job Van 't Veer
- Department of Healthcare and Welfare, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
| | - Nynke Boonstra
- Department of Psychiatry, Utrecht University Medical Center, Utrecht, Netherlands
- Department of Healthcare and Welfare, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
- KieN VIP Mental Health Care Services, Leeuwarden, Netherlands
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ter Harmsel JF, Noordzij ML, van der Pol TM, Swinkels LTA, Goudriaan AE, Popma A. Exploring the effects of a wearable biocueing app (Sense-IT) as an addition to aggression regulation therapy in forensic psychiatric outpatients. Front Psychol 2023; 14:983286. [PMID: 36968738 PMCID: PMC10036768 DOI: 10.3389/fpsyg.2023.983286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/18/2023] [Indexed: 03/12/2023] Open
Abstract
ObjectivePreventing and reducing violence is of high importance for both individuals and society. However, the overall efficacy of current treatment interventions aimed at reducing aggressive behavior is limited. New technological-based interventions may enhance treatment outcomes, for instance by facilitating out-of-session practice and providing just-in-time support. Therefore, the aim of this study was to assess the effects of the Sense-IT biocueing app as an addition to aggression regulation therapy (ART) on interoceptive awareness, emotion regulation, and aggressive behavior among forensic outpatients.MethodsA combination of methods was used. Quantitatively, a pretest-posttest design was applied to explore group changes in aggression, emotion regulation, and anger bodily sensations associated with the combination of biocueing intervention and ART. Measures were assessed at pretest, after 4 weeks posttest, and after one-month follow-up. During the 4 weeks, a single-case experimental ABA design was applied for each participant. Biocueing was added in the intervention phase. During all phases anger, aggressive thoughts, aggressive behavior, behavioral control, and physical tension were assessed twice a day, and heart rate was measured continuously. Qualitative information regarding interoceptive awareness, coping, and aggression was collected at posttest. 25 forensic outpatients participated.ResultsA significant decrease in self-reported aggression was found between pre- and posttest. Furthermore, three-quarters of participants reported increased interoceptive awareness associated with the biocueing intervention. However, the repeated ambulatory measurements of the single-case experimental designs (SCEDs) did not indicate a clear effect favoring the addition of biocueing. On group level, no significant effects were found. On the individual level, effects favoring the intervention were only found for two participants. Overall, effect sizes were small.ConclusionBiocueing seems a helpful addition to increase interoceptive awareness among forensic outpatients. However, not all patients benefit from the current intervention and, more specifically, from its behavioral support component aimed at enhancing emotion regulation. Future studies should therefore focus on increasing usability, tailoring the intervention to individual needs, and on integration into therapy. Individual characteristics associated with effective support by a biocueing intervention should be further investigated, as the use of personalized and technological-based treatment interventions is expected to increase in the coming years.
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Affiliation(s)
- Janna F. ter Harmsel
- Forensic Mental Healthcare, Inforsa, Amsterdam, Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- *Correspondence: Janna F. ter Harmsel,
| | - Matthijs L. Noordzij
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Thimo M. van der Pol
- Forensic Mental Healthcare, Inforsa, Amsterdam, Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Research and Quality of Care, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Lise T. A. Swinkels
- Forensic Mental Healthcare, Inforsa, Amsterdam, Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anna E. Goudriaan
- Department of Research and Quality of Care, Arkin Mental Health Institute, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Addiction Research, Amsterdam, Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Lentferink A, Oldenhuis H, Velthuijsen H, van Gemert-Pijnen L. How Reflective Automated e-Coaching Can Help Employees Improve Their Capacity for Resilience: Mixed Methods Study. JMIR Hum Factors 2023; 10:e34331. [PMID: 36897635 DOI: 10.2196/34331] [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: 10/18/2021] [Revised: 07/10/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND An eHealth tool that coaches employees through the process of reflection has the potential to support employees with moderate levels of stress to increase their capacity for resilience. Most eHealth tools that include self-tracking summarize the collected data for the users. However, users need to gain a deeper understanding of the data and decide upon the next step to take through self-reflection. OBJECTIVE In this study, we aimed to examine the perceived effectiveness of the guidance offered by an automated e-Coach during employees' self-reflection process in gaining insights into their situation and on their perceived stress and resilience capacities and the usefulness of the design elements of the e-Coach during this process. METHODS Of the 28 participants, 14 (50%) completed the 6-week BringBalance program that allowed participants to perform reflection via four phases: identification, strategy generation, experimentation, and evaluation. Data collection consisted of log data, ecological momentary assessment (EMA) questionnaires for reflection provided by the e-Coach, in-depth interviews, and a pre- and posttest survey (including the Brief Resilience Scale and the Perceived Stress Scale). The posttest survey also asked about the utility of the elements of the e-Coach for reflection. A mixed methods approach was followed. RESULTS Pre- and posttest scores on perceived stress and resilience were not much different among completers (no statistical test performed). The automated e-Coach did enable users to gain an understanding of factors that influenced their stress levels and capacity for resilience (identification phase) and to learn the principles of useful strategies to improve their capacity for resilience (strategy generation phase). Design elements of the e-Coach reduced the reflection process into smaller steps to re-evaluate situations and helped them to observe a trend (identification phase). However, users experienced difficulties integrating the chosen strategies into their daily life (experimentation phase). Moreover, the identified events related to stress and resilience were too specific through the guidance offered by the e-Coach (identification phase), and the events did not recur, which consequently left users unable to sufficiently practice (strategy generation phase), experiment (experimentation phase), and evaluate (evaluation phase) the techniques during meaningful events. CONCLUSIONS Participants were able to perform self-reflection under the guidance of the automated e-Coach, which often led toward gaining new insights. To improve the reflection process, more guidance should be offered by the e-Coach that would aid employees to identify events that recur in daily life. Future research could study the effects of the suggested improvements on the quality of reflection via an automated e-Coach.
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Affiliation(s)
- Aniek Lentferink
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Hilbrand Oldenhuis
- Marian van Os Centre for Entrepreneurship, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Hugo Velthuijsen
- Marian van Os Centre for Entrepreneurship, Hanze University of Applied Sciences, Groningen, Netherlands
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Diano F, Sica LS, Ponticorvo M. A Systematic Review of Mobile Apps as an Adjunct to Psychological Interventions for Emotion Dysregulation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1431. [PMID: 36674189 PMCID: PMC9864409 DOI: 10.3390/ijerph20021431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Mental health care has been enriched with the progressive use of technology during the last ten years, in particular after the COVID-19 pandemic. Mobile applications (apps) and smartphones have become the most widespread access point for many people who look for self-help in the psychological domain. OBJECTIVE We focused on a systematic review of mobile apps for mental health, focusing on the blending of apps with psychotherapy contexts, with a specific focus on emotional dysregulation. METHODS A comprehensive literature search (January 2017 to August 2022) in PubMed, PsycInfo, Web of Science, and the Cochrane Library was conducted. Abstracts were included if they described mental health mobile apps targeting emotional dysregulation and their use during ongoing psychological or psychotherapy treatment for adults and adolescents. RESULTS In total, 397 abstracts were identified; of these, 19 publications describing apps targeting borderline personality disorder, depression, anxiety, suicidal behaviors, and post-traumatic stress disorders met the inclusion criteria. CONCLUSIONS App-enhanced psychotherapy might be a winning combination in many scenarios, but at the same time, many issues must still be faced in this yet emerging scientific field. In conclusion, we tried to put together some major guidelines for mental health mobile app development in the context of psychological treatments.
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Bosch R, Chakhssi F, Noordzij ML. Acceptance and potential clinical added value of biocueing in forensic psychiatric patients with autism spectrum disorder and/or intellectual disability. Psychiatry Res 2022; 313:114645. [PMID: 35613509 DOI: 10.1016/j.psychres.2022.114645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 01/26/2023]
Abstract
Autism spectrum disorder (ASD) and intellectual disability (ID) are prevalent in forensic psychiatric samples. People with ASD and/or ID often experience difficulties in emotion processing which can lead to aggressive or self-harming behavior. The use of biocueing (using wearable technology to constantly monitor and provide feedback on bodily changes) shows promise for improving emotion processing and, thus, potentially reducing aggressive behavior in this population. Both qualitative and quantitative methods were used to examine the feasibility and acceptance of Sense-IT, a biocueing application, in a sample of forensic psychiatric patients with ASD and/or ID and their forensic psychiatric nurses. To our knowledge, the current study is the first to examine first-person experiences with biocueing in forensic psychiatric patients with ASD and/or ID. Results show that, in general, participants experienced the biocueing application as positive and are willing to use biocueing. This is an important finding since forensic patients are often unmotivated to engage with therapeutic techniques. An exploration of trends in aggression and self-harm prior to and during the use of biocueing showed no significant changes. Future research should focus on the way biocueing can be implemented in clinical practice.
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Affiliation(s)
- Rianne Bosch
- Forensic psychiatric department 'De Boog', Warnsveld, GGNet, the Netherlands
| | - Farid Chakhssi
- Forensic psychiatric department 'De Boog', Warnsveld, GGNet, the Netherlands; Centre for eHealth and Well-being Research, Department of Psychology, Health, and Technology, University of Twente, the Netherlands
| | - Matthijs L Noordzij
- Centre for eHealth and Well-being Research, Department of Psychology, Health, and Technology, University of Twente, the Netherlands.
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de Looff P, Duursma R, Noordzij M, Taylor S, Jaques N, Scheepers F, de Schepper K, Koldijk S. Wearables: An R Package With Accompanying Shiny Application for Signal Analysis of a Wearable Device Targeted at Clinicians and Researchers. Front Behav Neurosci 2022; 16:856544. [PMID: 35813597 PMCID: PMC9262092 DOI: 10.3389/fnbeh.2022.856544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022] Open
Abstract
Physiological signals (e.g., heart rate, skin conductance) that were traditionally studied in neuroscientific laboratory research are currently being used in numerous real-life studies using wearable technology. Physiological signals obtained with wearables seem to offer great potential for continuous monitoring and providing biofeedback in clinical practice and healthcare research. The physiological data obtained from these signals has utility for both clinicians and researchers. Clinicians are typically interested in the day-to-day and moment-to-moment physiological reactivity of patients to real-life stressors, events, and situations or interested in the physiological reactivity to stimuli in therapy. Researchers typically apply signal analysis methods to the data by pre-processing the physiological signals, detecting artifacts, and extracting features, which can be a challenge considering the amount of data that needs to be processed. This paper describes the creation of a “Wearables” R package and a Shiny “E4 dashboard” application for an often-studied wearable, the Empatica E4. The package and Shiny application can be used to visualize the relationship between physiological signals and real-life stressors or stimuli, but can also be used to pre-process physiological data, detect artifacts, and extract relevant features for further analysis. In addition, the application has a batch process option to analyze large amounts of physiological data into ready-to-use data files. The software accommodates users with a downloadable report that provides opportunities for a careful investigation of physiological reactions in daily life. The application is freely available, thought to be easy to use, and thought to be easily extendible to other wearable devices. Future research should focus on the usability of the application and the validation of the algorithms.
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Affiliation(s)
- Peter de Looff
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- De Borg, Den Dolder, Netherlands
- Fivoor Science and Treatment Innovation, Den Dolder, Netherlands
- *Correspondence: Peter de Looff,
| | | | - Matthijs Noordzij
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Sara Taylor
- Affective Computing Group, Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Natasha Jaques
- Affective Computing Group, Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Floortje Scheepers
- PsyData Group, Department of Psychiatry, UMC Utrecht, Utrecht, Netherlands
| | - Kees de Schepper
- PsyData Group, Department of Psychiatry, UMC Utrecht, Utrecht, Netherlands
| | - Saskia Koldijk
- PsyData Group, Department of Psychiatry, UMC Utrecht, Utrecht, Netherlands
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van Lier HG, Noordzij ML, Pieterse ME, Postel MG, Vollenbroek-Hutten MM, de Haan HA, Schraagen JMC. An ideographic study into physiology, alcohol craving and lapses during one hundred days of daily life monitoring. Addict Behav Rep 2022; 16:100443. [PMID: 35855973 PMCID: PMC9287639 DOI: 10.1016/j.abrep.2022.100443] [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: 03/02/2022] [Revised: 05/21/2022] [Accepted: 06/22/2022] [Indexed: 12/04/2022] Open
Abstract
In a 100 days intensive study considerable intra- and interindividual differences were established in physiology and psychological craving of people with alcohol use disorder. For one third of the people heightened heart rate was associated with high craving. For most participants that reported lapses, lapses cooccurred with craving in at least 92% of the time. During treatment ambulatory physiological data can support the detection and discussion of possible high risk craving situations in innovative and reliable ways.
Introduction Alcohol craving is a highly challenging obstacle to achieve long-term abstinence. Making alcohol use disorder patients timely aware of high-risk craving situations may protect them against relapse by prompting them to mobilize their coping resources. Current advances in wearable and smart-phone technology provide novel opportunities for the development of detecting these situations of heightened risk of craving, by enabling continuous tracking of fluctuations in psychological and physiological parameters. The present study therefore aims to determine the association between self-reported craving and relapses, and between heightened physiological activity. Specifically, we measured cardiovascular and electrodermal activity, and self-reported craving during one hundred days in the daily life of people trying to recover from alcoholism. The secondary aim is to study whether the association between physiology and craving can be strengthened by the inclusion of context related psychological parameters. Methods An intensive repeated and continuous measures in naturalistic settings case-study design was employed. Ten participants were monitored with wearable bio-sensors and answered multiple questions every three hours on a smartphone app about craving, lapsing and multiple evidence based contextual variables. The association between physiology, craving and lapses was explored using Matthews correlation coefficients both with a current and 3 h lagged design. The contextual variables were included in a decision tree together with the physiological parameters to explore the added effect on the correlation of these contextual variables. Results The association between lapses and craving was highly different across individuals, varying between a weak to a strong association. The association between cardiovascular activity and heightened self-reported craving was negligible to weak, however with a high specificity, meaning that most craving events were accompanied by increase heart rate. However, the association between electrodermal activity and craving was lower than with cardiovascular activity for most participants, both prior (lagged) and during craving. For two of the participants the association between physiology and craving improved by adding contextual variables, however, precision was too low. Conclusions People differ strongly in their bodily reactions and psychological experiences during the first months of their addiction treatment. No individual in our study had unique one-to-one mappings between on the one hand physiological or psychological precursors, and on the other hand craving and (re)lapses. Therefore, detecting high risk craving situations with both physiological activity measured with wearables and psychological precursors to alert people specifically for an imminent (re)lapse, does not seem viable on the basis of the current results. We do see an added benefit of using physiology during treatment, as physiology can help start the conversation about possible high risk craving situations during that week. This would also help the counselor to gain added insights into the fluctuating states of the clients, and help to ameliorate the recall bias of clients. The present study showed the possibility and paved the way for future intensive longitudinal designs integrating both physiological, psychological and contextual factors during the challenging and lengthy recovery from addiction.
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12
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Abstract
BACKGROUND Digital phenotyping has been defined as the moment-by-moment assessment of an illness state through digital means, promising objective, quantifiable data on psychiatric patients' conditions, and could potentially improve diagnosis and management of mental illness. As it is a rapidly growing field, it is to be expected that new literature is being published frequently. OBJECTIVE We conducted this scoping review to assess the current state of literature on digital phenotyping and offer some discussion on the current trends and future direction of this area of research. METHODS We searched four databases, PubMed, Ovid MEDLINE, PsycINFO and Web of Science, from inception to August 25th, 2021. We included studies written in English that 1) investigated or applied their findings to diagnose psychiatric disorders and 2) utilized passive sensing for management or diagnosis. Protocols were excluded. A narrative synthesis approach was used, due to the heterogeneity and variability in outcomes and outcome types reported. RESULTS Of 10506 unique records identified, we included a total of 107 articles. The number of published studies has increased over tenfold from 2 in 2014 to 28 in 2020, illustrating the field's rapid growth. However, a significant proportion of these (49% of all studies and 87% of primary studies) were proof of concept, pilot or correlational studies examining digital phenotyping's potential. Most (62%) of the primary studies published evaluated individuals with depression (21%), BD (18%) and SZ (23%) (Appendix 1). CONCLUSION There is promise shown in certain domains of data and their clinical relevance, which have yet to be fully elucidated. A consensus has yet to be reached on the best methods of data collection and processing, and more multidisciplinary collaboration between physicians and other fields is needed to unlock the full potential of digital phenotyping and allow for statistically powerful clinical trials to prove clinical utility.
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Affiliation(s)
- Alex Z R Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore City, Singapore
| | - Melvyn W B Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore City, Singapore.,National Addictions Management Service, Institute of Mental Health, Singapore City, Singapore
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13
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van Doorn M, Nijhuis LA, Monsanto A, van Amelsvoort T, Popma A, Jaspers MWM, Noordzij ML, Öry FG, Alvarez-Jimenez M, Nieman DH. Usability, Feasibility, and Effect of a Biocueing Intervention in Addition to a Moderated Digital Social Therapy-Platform in Young People With Emerging Mental Health Problems: A Mixed-Method Approach. Front Psychiatry 2022; 13:871813. [PMID: 35693972 PMCID: PMC9174529 DOI: 10.3389/fpsyt.2022.871813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/22/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction To optimize treatment, it is of utmost importance to take into account the myriad of biological, social, and psychological changes that young people go through during adolescence which make them more vulnerable for developing mental health problems. Biocueing, a non-invasive method to transform physiological parameters into an observable signal, could strengthen stress- and emotion regulation by cueing physiologically unusual values in daily life. The aim of this study is to investigate the usability, feasibility, and exploratory effect of biocueing in addition to ENgage YOung people earlY (ENYOY), a moderated digital social therapy-platform, in young people with emerging mental health complaints. Methods A user-centered mixed-method design was used. A focus group was conducted to optimize the ENYOY-platform and biocueing intervention. Biocueing was operationalized by a smartwatch and the Sense-IT app. A within-subjects design was used; 10 days for all participants 'biofeedback off' (control), followed by 10 days 'biofeedback on' (experimental). Emotional awareness and perceived stress were measured using ecological momentary assessment. Eight individuals participated. User-friendliness, usability, and acceptance were assessed using a qualitative design. Results Findings from the focus group resulted in several adaptations of the biocueing intervention to the ENYOY-platform and vice versa. The average measurement compliance rate was 78.8%. Level-one findings showed different individual effects on perceived stress and emotional awareness. Level-two analyses showed no overall effects on perceived stress (B = -0.020, p = 0.562) and overall positive effects on emotional awareness (B = 0.030, p = 0.048) with small effect sizes (Improvement Rate Difference = 0.05-0.35). The intervention was found to be acceptable and showed moderate usability. Participants indicated they experienced improvements in reflection on feelings and changes in behavior, such as pausing and evaluating the situation. Conclusion These preliminary results show that biocueing could be a promising addition to digital treatment platforms and help young people become more emotionally aware. Improvements should be made regarding the usability and acceptability of the smartwatch, as well as more extensive integration of the biocueing intervention with a digital treatment platform. It would be relevant to gain a better understanding of which individuals would benefit most from an additional biocueing intervention.
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Affiliation(s)
| | | | - Anne Monsanto
- Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Arne Popma
- Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Monique W. M. Jaspers
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC-Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Matthijs L. Noordzij
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | | | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
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14
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van der Boom B, Boumparis N, Donker T, de Beurs D, Arntz A, Riper H. Internet-delivered interventions for personality disorders - A scoping review. Internet Interv 2022; 28:100525. [PMID: 35450140 PMCID: PMC9018158 DOI: 10.1016/j.invent.2022.100525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/02/2022] [Accepted: 03/12/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Personality disorders (PDs) form a substantial part of the mental health disease burden. Effective therapies to treat PDs exist, but they are time-consuming, costly, and difficult to scale up. Delivery through the internet could facilitate the scalability of effective treatment methods. OBJECTIVE This review summarizes existing evidence on internet-delivered psychotherapy for personality disorders. METHODS Because few randomized controlled trials (RCTs) have been carried out, we conducted a scoping review. We performed a systematic literature search in PubMed, Embase, MEDLINE, CINAHL, PsycInfo, and Cochrane. Studies were selected if they conveyed research findings on internet-delivered PD interventions. RESULTS Eleven studies were included. The majority (n = 8) focused specifically on borderline personality disorder (BPD) and the other three on PD in general. The most frequently used form of intervention (n = 7) was the addition of a mobile app to a conventional evidence-based face-to-face treatment such as dialectical behavioral therapy (DBT). Most interventions (n = 8) were still in the development and piloting phase; only two RCTs were found. Usability and patient satisfaction were moderate to high in all studies. Three studies demonstrated significant decreases in borderline personality disorder symptoms.The majority of the studies found were pilot or feasibility studies, most involving mobile apps offered in addition to face-to-face treatment. The add-ons were rated feasible, acceptable, and useful by patients. Reported challenges involved technical difficulties such as programming errors and bugs. Only 45% of the included studies reported on changes in PD symptoms, all showing reduction of symptoms and absence of adverse effects. CONCLUSIONS This scoping review found that internet interventions for PD are still under-researched, although initial outcomes show promise. The outcomes also encourage future research in terms of developing internet interventions as an add-on to existing treatments, as well as working toward the creation and testing of more encompassing internet-delivered treatments for PD.
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Affiliation(s)
- Bram van der Boom
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands,Corresponding author at: Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, Netherlands.
| | - Nikolaos Boumparis
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands
| | - Tara Donker
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands,Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB Amsterdam, Netherlands,Laboratory of Biological and Personality Psychology, Department of Psychology, University of Freiburg, Engelbergerstr, 41, D-79085 Freiburg im Breisgau, Germany
| | - Derek de Beurs
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands,Trimbos Institute—Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Postbus 15804, 1001 NH Amsterdam, Netherlands
| | - Heleen Riper
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands,Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB Amsterdam, Netherlands,GGZ inGeest Specialized Mental Health Care, VU University Medical Centre, De Boelelaan 1118, 1081 HZ Amsterdam, Netherlands,Research Unit for Telepsychiatry and E-mental Health, Department of Clinical Research, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark,Faculty of Medicine, FI-20014, University of Turku, Turku, Finland
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15
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Kip H, Keizer J, da Silva MC, Beerlage-de Jong N, Köhle N, Kelders SM. Methods for Human-Centered eHealth Development: Narrative Scoping Review. J Med Internet Res 2022; 24:e31858. [PMID: 35084359 PMCID: PMC8832261 DOI: 10.2196/31858] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022] Open
Abstract
Background Thorough holistic development of eHealth can contribute to a good fit among the technology, its users, and the context. However, despite the availability of frameworks, not much is known about specific research activities for different aims, phases, and settings. This results in researchers having to reinvent the wheel. Consequently, there is a need to synthesize existing knowledge on research activities for participatory eHealth development processes. Objective The 3 main goals of this review are to create an overview of the development strategies used in studies based on the CeHRes (Center for eHealth Research) Roadmap, create an overview of the goals for which these methods can be used, and provide insight into the lessons learned about these methods. Methods We included eHealth development studies that were based on the phases and/or principles of the CeHRes Roadmap. This framework was selected because of its focus on participatory, iterative eHealth design in context and to limit the scope of this review. Data were extracted about the type of strategy used, rationale for using the strategy, research questions, and reported information on lessons learned. The most frequently mentioned lessons learned were summarized using a narrative, inductive approach. Results In the included 160 papers, a distinction was made between overarching development methods (n=10) and products (n=7). Methods are used to gather new data, whereas products can be used to synthesize previously collected data and support the collection of new data. The identified methods were focus groups, interviews, questionnaires, usability tests, literature studies, desk research, log data analyses, card sorting, Delphi studies, and experience sampling. The identified products were prototypes, requirements, stakeholder maps, values, behavior change strategies, personas, and business models. Examples of how these methods and products were applied in the development process and information about lessons learned were provided. Conclusions This study shows that there is a plethora of methods and products that can be used at different points in the development process and in different settings. To do justice to the complexity of eHealth development, it seems that multiple strategies should be combined. In addition, we found no evidence for an optimal single step-by-step approach to develop eHealth. Rather, researchers need to select the most suitable research methods for their research objectives, the context in which data are collected, and the characteristics of the participants. This study serves as a first step toward creating a toolkit to support researchers in applying the CeHRes Roadmap to practice. In this way, they can shape the most suitable and efficient eHealth development process.
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Affiliation(s)
- Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Department of Research, Transfore, Deventer, Netherlands
| | - Julia Keizer
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Marcia C da Silva
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Nienke Beerlage-de Jong
- Department of Health Technology & Services Research, University of Twente, Enschede, Netherlands
| | - Nadine Köhle
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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16
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Xie Q, Torous J, Goldberg SB. E-Mental Health for People with Personality Disorders: A Systematic Review. Curr Psychiatry Rep 2022; 24:541-552. [PMID: 35972718 PMCID: PMC9379895 DOI: 10.1007/s11920-022-01360-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Provision of mental health services through digital technologies (e-mental health) can potentially expand access to treatments for personality disorders (PDs). We evaluated studies on e-mental health for PDs published over the last 3 years (2019-2022). RECENT FINDINGS Studies published in English that used e-mental health to treat people with PDs or PD-related symptoms were identified. We identified 19 studies, including four randomized controlled trials and one meta-analysis. Most interventions were based on Dialectical Behavior Therapy and delivered through smartphone applications for adults with Borderline Personality Disorder [BPD] or related symptoms. User experiences of the interventions were generally positive. Evidence for efficacy was limited. The current literature on e-mental health for PDs is limited in scope. Research in understudied populations and randomized controlled trials designed to establish efficacy are warranted. It is not yet clear whether e-mental health may be helpful for the treatment of PDs.
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Affiliation(s)
- Qiang Xie
- Department of Counseling Psychology, University of Wisconsin-Madison, 335 Education Building, 1000 Bascom Mall, Madison, WI, 53706, USA
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Simon B Goldberg
- Department of Counseling Psychology, University of Wisconsin-Madison, 335 Education Building, 1000 Bascom Mall, Madison, WI, 53706, USA.
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA.
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17
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Ter Harmsel A, van der Pol T, Swinkels L, Goudriaan AE, Popma A, Noordzij ML. Development of a Wearable Biocueing App (Sense-IT) Among Forensic Psychiatric Outpatients With Aggressive Behavior: Design and Evaluation Study. JMIR Form Res 2021; 5:e29267. [PMID: 34821567 PMCID: PMC8663672 DOI: 10.2196/29267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/13/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022] Open
Abstract
Background The ability to regulate anger is often impaired in forensic psychiatric patients, frequently resulting in aggressive behavior. Although some treatment programs are partially successful in enhancing aggression regulation and reducing recidivism among specific subgroups, generalizable conclusions on the effectiveness of these interventions cannot be drawn to date. In forensic outpatient care, low treatment adherence and a predominant focus on cognitive control in most treatment programs may entail some of the factors impeding treatment. Technology-based interventions may address some of these treatment challenges. Objective The aim of this study is to explore whether a new technology-based biocueing intervention, the Sense-IT app, can be a valuable addition to aggression regulation treatment programs in forensic outpatient care. The Sense-IT app, which provides the user with real-time physiological feedback and behavioral support, is developed to strengthen emotional awareness and facilitate real-life practice. In this study, we aim to develop and evaluate an updated version of the Sense-IT app that is suitable for forensic outpatients with aggressive behavior. Methods First, we conducted a design study to assess the attitudes of forensic professionals and patients toward biocueing and to collect requirements for a biocueing app for this specific population. On the basis of this information, we developed an updated version of the Sense-IT app. In an evaluation study, 10 forensic outpatients used the app for 2 weeks. The app’s acceptability, usability, and clinical outcomes (aggression, anger, and recognition of bodily signals related to anger) were measured before and after the intervention using both quantitative and qualitative measures. Results The design study revealed a cautiously positive attitude toward the use of biocueing as an addition to aggression regulation therapy. The evaluation study among forensic outpatients demonstrated moderate acceptability and adequate usability for the new version of the Sense-IT app. Exploratory analysis revealed a significant decrease in trait aggression postintervention; no significant changes were found in other anger-related clinical outcomes. To further increase acceptability and usability, a stable functioning app with self-adjustable settings, the use of smartwatches with a longer battery life, and the use of the patient’s own smartphone devices were recommended. Conclusions This study, which is one of the first attempts to enroll and evaluate the real-life use of a biocueing intervention among forensic outpatients, emphasized the importance of involving both patients and therapists throughout the development and implementation process. In the future, experimental studies, including single-case experimental designs using ecological momentary assessment, should be performed to evaluate the effectiveness of the Sense-IT intervention on clinical outcomes. An open attitude toward new technology, allowing exploration of the potential benefits of the Sense-IT app case-by-case, and training of therapists in using the app are expected to facilitate its integration in therapy.
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Affiliation(s)
- Annemieke Ter Harmsel
- Inforsa, Forensic Mental Health Care, Amsterdam, Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Research and Quality of Care, Arkin, Amsterdam, Netherlands
| | - Thimo van der Pol
- Inforsa, Forensic Mental Health Care, Amsterdam, Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Research and Quality of Care, Arkin, Amsterdam, Netherlands
| | - Lise Swinkels
- Inforsa, Forensic Mental Health Care, Amsterdam, Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Research and Quality of Care, Arkin, Amsterdam, Netherlands
| | - Anna E Goudriaan
- Department of Research and Quality of Care, Arkin, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Matthijs L Noordzij
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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18
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Laursen SL, Helweg-Jørgensen S, Langergaard A, Søndergaard J, Sørensen SS, Mathiasen K, Lichtenstein MB, Ehlers LH. Mobile Diary App Versus Paper-Based Diary Cards for Patients With Borderline Personality Disorder: Economic Evaluation. J Med Internet Res 2021; 23:e28874. [PMID: 34762057 PMCID: PMC8663638 DOI: 10.2196/28874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/17/2021] [Accepted: 07/27/2021] [Indexed: 01/27/2023] Open
Abstract
Background The cost-effectiveness of using a mobile diary app as an adjunct in dialectical behavior therapy (DBT) in patients with borderline personality disorder is unknown. Objective This study aims to perform an economic evaluation of a mobile diary app compared with paper-based diary cards in DBT treatment for patients with borderline personality disorder in a psychiatric outpatient facility. Methods This study was conducted alongside a pragmatic, multicenter, randomized controlled trial. The participants were recruited at 5 Danish psychiatric outpatient facilities and were randomized to register the emotions, urges, and skills used in a mobile diary app or on paper-based diary cards. The participants in both groups received DBT delivered by the therapists. A cost-consequence analysis with a time horizon of 12 months was performed. Consequences included quality-adjusted life years (QALYs), depression severity, borderline severity, suicidal behavior, health care use, treatment compliance, and system usability. All relevant costs were included. Focus group interviews were conducted with patients, therapists, researchers, and industry representatives to discuss the potential advantages and disadvantages of using a mobile diary app. Results A total of 78 participants were included in the analysis. An insignificantly higher number of participants in the paper group dropped out before the start of treatment (P=.07). Of those starting treatment, participants in the app group had an average of 37.1 (SE 27.55) more days of treatment and recorded an average of 3.16 (SE 5.10) more skills per week than participants in the paper group. Participants in both groups had a QALY gain and a decrease in depression severity, borderline severity, and suicidal behavior. Significant differences were found in favor of the paper group for both QALY gain (adjusted difference −0.054; SE 0.03) and reduction in depression severity (adjusted difference −1.11; SE 1.57). The between-group difference in total costs ranged from US $107.37 to US $322.10 per participant during the 12 months. The use of services in the health care sector was similar across both time points and groups (difference: psychiatric hospitalization <5 and <5; general practice −1.32; SE 3.68 and 2.02; SE 3.19). Overall, the patients showed high acceptability and considered the app as being easy to use. Therapists worried about potential negative influences on the therapist-patient interaction from new work tasks accompanying the introduction of the new technology but pointed at innovation potential from digital database registrations. Conclusions This study suggests both positive and negative consequences of mobile diary apps as adjuncts to DBT compared with paper diary cards. More research is needed to draw conclusions regarding its cost-effectiveness. Trial Registration ClinicalTrials.gov NCT03191565; http://clinicaltrials.gov/ct2/show/NCT03191565 International Registered Report Identifier (IRRID) RR2-10.2196/17737
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Affiliation(s)
- Sidsel Lund Laursen
- Department of Clinical Medicine, Danish Center for Healthcare Improvements, Aalborg University, Aalborg Oest, Denmark
| | - Stig Helweg-Jørgensen
- Research Unit for Telepsychiatry and E-mental Health, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Astrid Langergaard
- Department of Clinical Medicine, Danish Center for Healthcare Improvements, Aalborg University, Aalborg Oest, Denmark
| | - Jesper Søndergaard
- Department of Clinical Medicine, Danish Center for Healthcare Improvements, Aalborg University, Aalborg Oest, Denmark
| | - Sabrina Storgaard Sørensen
- Department of Clinical Medicine, Danish Center for Healthcare Improvements, Aalborg University, Aalborg Oest, Denmark
| | - Kim Mathiasen
- Research Unit for Telepsychiatry and E-mental Health, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mia Beck Lichtenstein
- Research Unit for Telepsychiatry and E-mental Health, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Holger Ehlers
- Department of Clinical Medicine, Danish Center for Healthcare Improvements, Aalborg University, Aalborg Oest, Denmark
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19
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de Looff PC, Cornet LJM, de Kogel CH, Fernández-Castilla B, Embregts PJCM, Didden R, Nijman HLI. Heart Rate and Skin Conductance Associations with Physical Aggression, Psychopathy, Antisocial Personality Disorder and Conduct Disorder: An Updated Meta-Analysis. Neurosci Biobehav Rev 2021; 132:553-582. [PMID: 34774587 DOI: 10.1016/j.neubiorev.2021.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/14/2021] [Accepted: 11/03/2021] [Indexed: 01/06/2023]
Abstract
The associations between physiological measures (i.e., heart rate and skin conductance) of autonomic nervous system (ANS) activity and severe antisocial spectrum behavior (AB) were meta-analyzed. We used an exhaustive partitioning of variables relevant to the ANS-AB association and investigated four highly relevant questions (on declining effect sizes, psychopathy subscales, moderators, and ANS measures) that are thought to be transformative for future research on AB. We investigated a broad spectrum of physiological measures (e.g., heart rate (variability), pre-ejection period) in relation to AB. The search date for the current meta-analysis was on January 1st, 2020, includes 101 studies and 769 effect sizes. Results indicate that effect sizes are heterogeneous and bidirectional. The careful partitioning of variables sheds light on the complex associations that were obscured in previous meta-analyses. Effects are largest for the most violent offenders and for psychopathy and are dependent on the experimental tasks used, parameters calculated, and analyses run. Understanding the specificity of physiological reactions may be expedient for differentiating between (and within) types of AB.
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Affiliation(s)
- Peter C de Looff
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Fivoor, Science and Treatment Innovation, Den Dolder, the Netherlands; Expertcentre "De Borg", Den Dolder, the Netherlands.
| | - Liza J M Cornet
- Institute of Education and Child Studies, Leiden University, Leiden, the Netherlands
| | - Catharina H de Kogel
- Research and Documentation Centre (WODC), Ministry of Justice and Security, The Hague, the Netherlands
| | | | - Petri J C M Embregts
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Robert Didden
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Expertcentre "De Borg", Den Dolder, the Netherlands; Trajectum, Specialized and Forensic Care, Zwolle, the Netherlands
| | - Henk L I Nijman
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Fivoor, Science and Treatment Innovation, Den Dolder, the Netherlands; Expertcentre "De Borg", Den Dolder, the Netherlands
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20
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Ingvaldsen SH, Tronvik E, Brenner E, Winnberg I, Olsen A, Gravdahl GB, Stubberud A. A Biofeedback App for Migraine: Development and Usability Study. JMIR Form Res 2021; 5:e23229. [PMID: 34319243 PMCID: PMC8367148 DOI: 10.2196/23229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/17/2021] [Accepted: 05/31/2021] [Indexed: 12/04/2022] Open
Abstract
Background Biofeedback is effective in treating migraines. It is believed to have a beneficial effect on autonomous nervous system activity and render individuals resilient to stressors that may trigger a migraine. However, widespread use of biofeedback is hampered by the need for a trained therapist and specialized equipment. Emerging digital health technology, including smartphones and wearables (mHealth), enables new ways of administering biofeedback. Currently, mHealth interventions for migraine appear feasible, but development processes and usability testing remain insufficient. Objective The objective of this study was to evaluate and improve the feasibility and usability of an mHealth biofeedback treatment app for adults with migraine. Methods In a prospective development and usability study, 18 adults with migraine completed a 4-week testing period of self-administered therapist-independent biofeedback treatment consisting of a smartphone app connected to wearable sensors (Cerebri, Nordic Brain Tech AS). The app included biofeedback training, instructions for self-delivery, and a headache diary. Two wearable sensors were used to measure surface electromyographic voltage at the trapezius muscle and peripheral skin temperature and heart rate at the right second fingertip. Participants were instructed to complete a daily headache diary entry and biofeedback session of 10 minutes duration. The testing period was preceded by a preusability expectation interview and succeeded by a postusability experience interview. In addition, an evaluation questionnaire was completed at weeks 2 and 4. Adherence was calculated as the proportion of 10-minute sessions completed within the first 28 days of treatment. Usability and feasibility were analyzed and summarized quantitatively and qualitatively. Results A total of 391 biofeedback sessions were completed with a median of 25 (IQR 17-28) per participant. The mean adherence rate was 0.76 (SD 0.26). The evaluation questionnaire revealed that functionality and design had the highest scores, whereas engagement and biofeedback were lower. Qualitative preexpectation analysis revealed that participants expected to become better familiar with physical signals and gain more understanding of their migraine attacks and noted that the app should be simple and understandable. Postusability analysis indicated that participants had an overall positive user experience with some suggestions for improvement regarding the design of the wearables and app content. The intervention was safe and tolerable. One case of prespecified adverse events was recorded in which a patient developed a skin rash from the sticky surface electromyography electrodes. Conclusions The app underwent a rigorous development process that indicated an overall positive user experience, good usability, and high adherence rate. This study highlights the value of usability testing in the development of mHealth apps.
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Affiliation(s)
- Sigrid Hegna Ingvaldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erling Tronvik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,National Advisory Unit on Headaches, Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Eiliv Brenner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,National Advisory Unit on Headaches, Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Ingunn Winnberg
- National Advisory Unit on Headaches, Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim, Norway
| | - Gøril Bruvik Gravdahl
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,National Advisory Unit on Headaches, Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Anker Stubberud
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,National Advisory Unit on Headaches, Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
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21
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de Looff PC, Nijman H, Didden R, Noordzij ML. Usability and Acceptance of Wearable Biosensors in Forensic Psychiatry: Cross-sectional Questionnaire Study. JMIR Form Res 2021; 5:e18096. [PMID: 33970115 PMCID: PMC8145084 DOI: 10.2196/18096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 10/14/2020] [Accepted: 04/13/2021] [Indexed: 01/23/2023] Open
Abstract
Background The use of wearable biosensor devices for monitoring and coaching in forensic psychiatric settings yields high expectations for improved self-regulation of emotions and behavior in clients and staff members. More so, if clients have mild intellectual disabilities (IQ 50-85), they might benefit from these biosensors as they are easy to use in everyday life, which ensures that clients can practice with the devices in multiple stress and arousal-inducing situations. However, research on (continuous) use and acceptance of biosensors in forensic psychiatry for clients with mild intellectual disabilities and their caretakers is scarce. Although wearable biosensors show promise for health care, recent research showed that the acceptance and continuous use of wearable devices in consumers is not as was anticipated, probably due to low expectations. Objective The main goal of this study was to investigate the associations between and determinants of the expectation of usability, the actual experienced usability, and the intention for continuous use of biosensors. Methods A total of 77 participants (31 forensic clients with mild intellectual disabilities and 46 forensic staff members) participated in a 1-week trial. Preceding the study, we selected 4 devices thought to benefit the participants in domains of self-regulation, physical health, or sleep. Qualitative and quantitative questionnaires were used that explored the determinants of usability, acceptance, and continuous use of biosensors. Questionnaires consisted of the System Usability Scale, the Technology Acceptance Model questionnaire, and the extended expectation confirmation model questionnaire. Results Only the experienced usability of the devices was associated with intended continuous use. Forensic clients scored higher on acceptance and intention for continuous use than staff members. Moderate associations were found between usability with acceptance and continuous use. Staff members showed stronger associations between usability and acceptance (r=.80, P<.001) and usability and continuous use (r=.79, P<.001) than clients, who showed more moderate correlations between usability and acceptance (r=.46, P=.01) and usability and continuous use (r=.52, P=.003). The qualitative questionnaires in general indicated that the devices were easy to use and gave clear information. Conclusions Contrary to expectations, it was the actual perceived usability of wearing a biosensor that was associated with continuous use and to a much lesser extent the expectancy of usability. Clients scored higher on acceptance and intention for continuous use, but associations between usability and both acceptance and continuous use were markedly stronger in staff members. This study provides clear directions on how to further investigate these associations. For example, whether this is a true effect or due to a social desirability bias in the client group must be investigated. Clients with mild intellectual disabilities might benefit from the ease of use of these devices and their continuing monitoring and coaching apps. For these clients, it is especially important to develop easy-to-use biosensors with a minimum requirement on cognitive capacity to increase usability, acceptance, and continuous use.
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Affiliation(s)
- Pieter Christiaan de Looff
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands.,De Borg, Den Dolder, Netherlands.,Fivoor Science and Treatment Innovation, Den Dolder, Netherlands
| | - Henk Nijman
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands.,Fivoor Science and Treatment Innovation, Den Dolder, Netherlands
| | - Robert Didden
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands.,Trajectum, Zwolle, Netherlands
| | - Matthijs L Noordzij
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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22
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Brouwer AM. Challenges and Opportunities in Consumer Neuroergonomics. FRONTIERS IN NEUROERGONOMICS 2021; 2:606646. [PMID: 38235238 PMCID: PMC10790888 DOI: 10.3389/fnrgo.2021.606646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/08/2021] [Indexed: 01/19/2024]
Affiliation(s)
- Anne-Marie Brouwer
- TNO The Netherlands Organisation for Applied Scientific Research, Soesterberg, Netherlands
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23
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Davis-Martin RE, Alessi SM, Boudreaux ED. Alcohol Use Disorder in the Age of Technology: A Review of Wearable Biosensors in Alcohol Use Disorder Treatment. Front Psychiatry 2021; 12:642813. [PMID: 33828497 PMCID: PMC8019775 DOI: 10.3389/fpsyt.2021.642813] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/12/2021] [Indexed: 02/05/2023] Open
Abstract
Biosensors enable observation and understanding of latent physiological occurrences otherwise unknown or invasively detected. Wearable biosensors monitoring physiological constructs across a wide variety of mental and physical health conditions have become an important trend in innovative research methodologies. Within substance use research, explorations of biosensor technology commonly focus on identifying physiological indicators of intoxication to increase understanding of addiction etiology and to inform treatment recommendations. In this review, we examine the state of research in this area as it pertains to treatment of alcohol use disorders specifically highlighting the gaps in our current knowledge with recommendations for future research. Annually, alcohol use disorders affect approximately 15 million individuals. A primary focus of existing wearable technology-based research among people with alcohol use disorders is identifying alcohol intoxication. A large benefit of wearable biosensors for this purpose is they provide continuous readings in a passive manner compared with the gold standard measure of blood alcohol content (BAC) traditionally measured intermittently by breathalyzer or blood draw. There are two primary means of measuring intoxication with biosensors: gait and sweat. Gait changes have been measured via smart sensors placed on the wrist, in the shoe, and mobile device sensors in smart phones. Sweat measured by transdermal biosensors detects the presence of alcohol in the blood stream correlating to BAC. Transdermal biosensors have been designed in tattoos/skin patches, shirts, and most commonly, devices worn on the ankle or wrist. Transdermal devices were initially developed to help monitor court-ordered sobriety among offenders with alcohol use disorder. These devices now prove most useful in continuously tracking consumption throughout clinical trials for behavioral treatment modalities. More recent research has started exploring the uses for physical activity trackers and physiological arousal sensors to guide behavioral interventions for relapse prevention. While research has begun to demonstrate wearable devices' utility in reducing alcohol consumption among individuals aiming to cutdown on their drinking, monitoring sustained abstinence in studies exploring contingency management for alcohol use disorders, and facilitating engagement in activity-based treatment interventions, their full potential to further aid in understanding of, and treatment for, alcohol use disorders has yet to be explored.
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Affiliation(s)
- Rachel E Davis-Martin
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sheila M Alessi
- Department of Medicine, Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Edwin D Boudreaux
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States
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24
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Ter Harmsel JF, Noordzij ML, Goudriaan AE, Dekker JJM, Swinkels LTA, van der Pol TM, Popma A. Biocueing and ambulatory biofeedback to enhance emotion regulation: A review of studies investigating non-psychiatric and psychiatric populations. Int J Psychophysiol 2020; 159:94-106. [PMID: 33248196 DOI: 10.1016/j.ijpsycho.2020.11.009] [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: 07/22/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
Over the last years, biofeedback applications are increasingly used to enhance interoceptive awareness and self-regulation, in psychiatry and beyond. These applications are used to strengthen emotion regulation skills by home training (ambulatory biofeedback) and real-time support in everyday life stressful situations (biocueing). Unfortunately, knowledge about the feasibility and effectivity of these applications is still scarce. Therefore, a systematic literature search was performed. In total, 30 studies (4 biocueing, 26 ambulatory biofeedback) were reviewed; 21 of these studies were conducted in non-psychiatric samples and 9 studies in psychiatric samples. Study characteristics, biofeedback characteristics, effectivity and feasibility outcomes were extracted. Despite the rapid advances in wearable technology, only a few biocueing studies were found. In the majority of the studies significant positive effects were found on self-reported (stress-related) psychological measures. Significant improvements on physiological measures were also reported, though these measures were used less frequently. Feasibility of the applications was often reported as sufficient, though not adequately assessed in most studies. Taken into account the small sample sizes and the limited quality of the majority of the studies in this recently emerging field, biocueing and ambulatory biofeedback interventions showed promising results. Future research is expected to be focusing on biocueing as a just-in-time adaptive intervention. To establish this research field, closer cooperation between research groups, use of more rigorous as well as individually tailored research designs and more valid feasibility and effectivity assessment are recommended.
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Affiliation(s)
- J F Ter Harmsel
- Inforsa, Forensic Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC, Department of Child and Adolescent Psychiatry and Psychology, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - M L Noordzij
- University of Twente, Department of Psychology, Health and Technology, Enschede, the Netherlands
| | - A E Goudriaan
- Arkin, Department of Research and Quality of Care, Amsterdam, the Netherlands; Amsterdam UMC, Department of Psychiatry, University of Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - J J M Dekker
- Arkin, Department of Research and Quality of Care, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Faculty of Behavioral and Movement Sciences, Amsterdam, the Netherlands
| | - L T A Swinkels
- Inforsa, Forensic Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC, Department of Child and Adolescent Psychiatry and Psychology, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - T M van der Pol
- Inforsa, Forensic Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC, Department of Child and Adolescent Psychiatry and Psychology, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - A Popma
- Amsterdam UMC, Department of Child and Adolescent Psychiatry and Psychology, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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25
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Helweg-Jørgensen S, Beck Lichtenstein M, Fruzzetti AE, Møller Dahl C, Pedersen SS. Daily Self-Monitoring of Symptoms and Skills Learning in Patients With Borderline Personality Disorder Through a Mobile Phone App: Protocol for a Pragmatic Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e17737. [PMID: 32449690 PMCID: PMC7281147 DOI: 10.2196/17737] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/27/2020] [Accepted: 03/11/2020] [Indexed: 12/30/2022] Open
Abstract
Background Patient self-monitoring via mobile phones during psychotherapy can enhance and provide an overview of psychotherapeutic progress by graphically displaying current and previous symptom scores, providing feedback to the patient, delivering psychoeducative material, and providing timely data to the therapist or treatment team. Objective This study will aim to assess the effects of using a mobile phone to self-monitor symptoms and acquire coping skills instead of using pen and paper during psychotherapy in patients with borderline personality disorder (BPD). Dialectical behavior therapy will be performed to treat BPD. The primary outcome is the mean time needed to learn coping skills directed at emotion regulation; the secondary outcome is changes in the BPD symptom score as measured by the Zanarini Rating Scale for Borderline Personality Disorder. Methods This study is a pragmatic, multicenter randomized controlled trial. Participants were recruited through five public general psychiatric outpatient treatment facilities in Denmark. Patients are randomly assigned, on a 1:1 basis, to either the mobile phone condition (using the Monsenso mDiary mobile app) or pen-and-paper condition. Patients will complete several self-report questionnaires on symptom severity; assessments by trained raters on BPD severity will be performed as well. Survival analysis with a shared frailty model will be used to assess the primary outcome. Results Recruitment began in June 2017 and was completed in February 2019 after 80 participants were recruited. The study ended in February 2020. It is expected that the benefits of mobile phone–based self-report compared to the pen-and-paper method will be demonstrated for skill learning speed and registration compliance. To our knowledge, this is the first trial exploring the impact of cloud-based mobile registration in BPD treatment. Conclusions This trial will report on the effectiveness of mobile phone–based self-monitoring during psychiatric treatment. It has the potential to contribute to evidence-based clinical practice since apps are already in use clinically. Trial Registration ClinicalTrials.gov NCT03191565; https://clinicaltrials.gov/ct2/show/NCT03191565 International Registered Report Identifier (IRRID) DERR1-10.2196/17737
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Affiliation(s)
- Stig Helweg-Jørgensen
- Research Unit for Telepsychiatry and E-mental Health, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.,Institute of Psychology, University of Southern Denmark, Odense, Denmark.,The Borderline Unit, Mental Health Services in the Region of Southern Denmark, Svendborg, Denmark.,Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Mia Beck Lichtenstein
- Research Unit for Telepsychiatry and E-mental Health, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alan E Fruzzetti
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Christian Møller Dahl
- Department of Business and Economics, University of Southern Denmark, Odense, Denmark
| | - Susanne S Pedersen
- Institute of Psychology, University of Southern Denmark, Odense, Denmark.,Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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