Acceptability of Interventions Delivered Online and Through Mobile Phones for People Who Experience Severe Mental Health Problems: A Systematic Review

Early psychosis service user views on digital remote monitoring: a qualitative study

BACKGROUND

Current approaches to mental healthcare for people with severe mental health problems are limited by sporadic monitoring and symptom recall bias. Emotional and behavioural markers generated by digital health technologies (DHTs) offer the potential to enhance quality of care and clinical decision-making. This study explored early psychosis service users' views and experiences of using a digital remote monitoring tool (ClinTouch app).

METHODS

Qualitative framework analysis was undertaken with interview data collected from participants who took part in the Actissist proof-of-concept and subsequent randomised controlled trial studies to understand the experiences of participants using the ClinTouch app (n = 8).

RESULTS

Data were summarised into four key themes. The following three themes were established a priori: (1) awareness of mood and symptoms; (2) acceptability of ClinTouch; and (3) improvements and recommendations. The fourth theme was established a posteriori: (4) integrating ClinTouch into clinical practice. More specifically, participants felt ClinTouch was an acceptable and useful tool for symptom monitoring. ClinTouch facilitated an increased awareness of mood and symptoms, which enabled participants to self-reflect and develop understanding of their own experiences.

CONCLUSIONS

This study shed light on early psychosis service users' experiences with using the ClinTouch digital remote monitoring app. ClinTouch was viewed as acceptable for monitoring symptoms, safe and easy to use, showed potential of integration with clinical care, and facilitated increased awareness and understanding of symptoms. Improvements including personalised question items and interactive features were suggested. Future developments of digital remote monitoring apps should include a more refined item set and personalisation features.

CLINICAL TRIAL NUMBER

ISRCTN34966555, Registration Date: 12/06/2014; ISRCTN76986679, Registration Date: 07/02/2018.

Exploring service users' and healthcare professionals' experience of digital and face-to-face Health Checks in England: a qualitative study

INTRODUCTION

In England, eligible adults aged 40-74 years are invited to attend a face-to-face (F2F) NHS Health Check appointment every 5 years. A digital version of the Health Check was introduced by a local authority as an alternative for those hesitant or less able to attend an F2F appointment.

OBJECTIVES

This qualitative study aimed to understand service users' (SUs) and healthcare professionals' (HCPs) experiences and opinions of F2F Health Checks and digital Health Checks (DHC), identify barriers and facilitators of the F2F Health Check and DHC pathways, and recommend potential improvements.

DESIGN

This is a qualitative study, involving interviews with a purposive sample of participants.

PARTICIPANTS AND SETTING

A purposive sample of 30 SUs and 8 HCPs were recruited by an external market service company in the London Borough of Southwark.

METHODS

Semistructured interviews were conducted, which included questions on understanding why SUs chose a type of Health Check, their experiences of the service and suggestions for improvement. HCP interviews covered HCP experiences of providing both services, including any impact on workload. The Framework method of thematic analysis was used to analyse the data.

RESULTS

SUs identified benefits of the DHC service including its convenience, ease of use and access. Both SUs and HCPs acknowledged the limitations of the DHC, including self-reporting physical measures (eg, blood pressure and cholesterol levels) or difficulties going elsewhere to measure them, and the lack of opportunity to discuss health with a professional. SUs and HCPs both noted the lack of available appointments and time constraints as barriers associated with the F2F service.

CONCLUSIONS

Both HCPs and SUs perceive that in its current form, the DHC has benefits and barriers to its use. If these are adequately addressed, the DHC may help address the demand and pressure within General Practitioner (GP) clinics.

TRIAL REGISTRATION NUMBER

This study was registered on the Open Science Framework: https://osf.io/y87zt/.

Psychosocial Interventions in the Rehabilitation and the Management of Psychosis and Schizophrenia: A Systematic Review on Digitally-Delivered Interventions

BACKGROUND

Schizophrenia and psychotic disorders are disabling, complex and severe psychiatric conditions, which may pose a significant therapeutic challenge. Integrating current psychopharmacological treatment with psychosocial interventions demonstrated a higher efficacy in terms of prognosis. However, most schizophrenia or psychotic patients may have restricted or no access to evidence-based psychosocial interventions, mainly due to poor dissemination of specialized interventions or stigma. Therefore, we aim to systematically review all studies about the current evidence on the feasibility, acceptability, efficacy, effectiveness, and benefits of digitally-delivered psychoeducational and psychosocial interventions for individuals suffering from schizophrenia or psychotic disorders.

METHODS

A systematic literature review was conducted of the literature from 2000 to 2024 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, by using PubMed-MEDLINE, Scopus and OVID databases and combining the search approach using both free text terms and Medical Subject Headings (MESH) headings for the topics "psychoeducation", "psychosocial intervention" and "psychosis" and "schizophrenia".

RESULTS

Out of a total of 3042 reviewed papers, 69 studies were included here. The interventions included web-based family and individual psychoeducation, integrated web-based therapy, social networking, peer and expert moderation, virtual reality-assisted and mobile-based psychosocial interventions. Results showed that digitally-delivered interventions have a positive effect in ensuring the continuity and maintenance of the effectiveness of psychosocial treatments, by providing personalized, flexible, and evidence-based interventions to patients with psychosis and/or schizophrenia. At the same time, the studies included demonstrated the acceptability and feasibility of this kind of intervention in clinical practice.

CONCLUSIONS

Digital interventions have the potential to deliver non-stigmatizing, constantly available psychosocial and psychoeducational interventions in psychosis and schizophrenia by increasing access to mental health care and not costly interventions. However, further randomized controlled trials (RCTs) and observational studies should compare and evaluate the effectiveness and feasibility of web-based vs. face-to-face psychosocial interventions amongst schizophrenia and psychosis individuals.

Just-In-Time Adaptive Interventions to Promote Behavioral Health: Protocol for a Systematic Review

BACKGROUND

The goal of just-in-time adaptive interventions (JITAIs) is to use mobile, digital tools to provide individuals with personalized interventions at the optimal time and in the optimal context. Accordingly, JITAIs are promising for advancing accessible, equitable, and evidence-based treatment for behavioral health. To guide future inquiry in this space, a review of the literature is needed to describe the state of research on JITAIs for behavioral health.

OBJECTIVE

This study aims to systematically review the literature to describe the landscape of existing JITAIs for behavioral health at any stage of intervention development. In addition, conditional upon a sufficiently homogeneous literature, we will conduct meta-analyses to investigate the effectiveness of JITAIs for promoting distal outcomes (here, aspects of behavioral health) and proximal outcomes (eg, emotion regulation).

METHODS

This systematic review is being conducted in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols). We developed our search strategy and executed the literature search in collaboration with biomedical librarians; 5 databases (PubMed, Embase, Cochrane Library, Web of Science: Core Collection, and APA PsycINFO) were searched, and results were managed using EndNote 20 (Clarivate). We are screening (title, abstract, and full text) all records in duplicate in Covidence according to eligibility criteria. Data items will be extracted, and risk of bias will be assessed in duplicate from the included articles in Covidence. We will summarize JITAI characteristics in tables and text. We will conduct meta-analyses for the distal and proximal outcomes conditional upon sufficient homogeneity in subgroups. Moderation (conditional upon sufficient heterogeneity of outcomes) and mediation (ie, whether changes in proximal outcomes mediate the relation between JITAIs and distal outcomes) will be conducted as appropriate. We will investigate publication bias and use the Grading of Recommendations Assessment, Development and Evaluation to characterize the quality of evidence of our estimates.

RESULTS

The search strategy was developed between July 2023 and November 2023. The literature search was executed between November 2023 and December 2023. Title and abstract screening began in December 2023, and full-text screening began in May 2024. Data extraction and analyses have not begun.

CONCLUSIONS

Here, we propose a systematic review to assess the state of the literature on JITAIs for behavioral health. The insights derived from this study will describe the literature on JITAIs in promoting behavioral health, reinforce JITAI definitions, clarify JITAI elements, and inform the next steps in JITAI research.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/58917.

Usefulness of self-guided digital services among mental health patients: The role of health confidence and sociodemographic characteristics

BACKGROUND

Remote services provided via telephone or the internet have become an essential part of mental health provision. Alongside services involving healthcare personnel (HCP), self-guided digital services hold great promise for improved self-management and health outcomes without increasing the burden on HCP. Therefore, better understanding of patients' use and experienced benefits of these services are needed. This study investigated how health confidence and sociodemographic background are associated with mental health patients' experiences of self-guided digital services.

METHODS

This cross-sectional survey study was performed in 2022 at a Finnish Mental Health and Substance Abuse Services (MHSAS) unit of a regional public service provider that serves a population of about 163000 people. All patients who had visited the unit up to 6 months before the study were invited to respond to an online survey on their experiences with the remote MHSAS. We report the average subjective usefulness of telephone, guided digital and self-guided digital services. Regression models were fitted to study the associations of patient characteristics with use of any digital service, and with experienced usefulness of self-guided digital services.

FINDINGS

The respondents (n = 438) rated the usefulness of telephone, guided digital and self-guided digital services similarly (4.0/5.0, 3.9/5.0, and 3.9/5.0, respectively). Health confidence was associated with not using digital services at all as well as with high perceived usefulness of self-guided services. While elderly patients were more likely to avoid using digital services, age was not associated with experienced usefulness of self-guided digital services. No association between unemployment status and experiences of digital services was found.

CONCLUSIONS

Different types of remote services are perceived as beneficial by mental health patients. To ensure effectiveness and equity, patients' health confidence should be considered when directing them to self-guided services. Elderly mental health patients who use digital services are equally able as younger patients to benefit from self-guided services.

Barriers and Facilitators of User Engagement With Digital Mental Health Interventions for People With Psychosis or Bipolar Disorder: Systematic Review and Best-Fit Framework Synthesis

BACKGROUND

Digital mental health interventions (DMHIs) to monitor and improve the health of people with psychosis or bipolar disorder show promise; however, user engagement is variable, and integrated clinical use is low.

OBJECTIVE

This prospectively registered systematic review examined barriers and facilitators of clinician and patient engagement with DMHIs, to inform implementation within real-world settings.

METHODS

A systematic search of 7 databases identified empirical studies reporting qualitative or quantitative data about factors affecting staff or patient engagement with DMHIs aiming to monitor or improve the mental or physical health of people with psychosis or bipolar disorder. The Consolidated Framework for Implementation Research was used to synthesize data on barriers and facilitators, following a best-fit framework synthesis approach.

RESULTS

The review included 175 papers (150 studies; 11,446 participants) describing randomized controlled trials; surveys; qualitative interviews; and usability, cohort, and case studies. Samples included people with schizophrenia spectrum psychosis (98/150, 65.3% of studies), bipolar disorder (62/150, 41.3% of studies), and clinicians (26/150, 17.3% of studies). Key facilitators were a strong recognition of DMHIs' relative advantages, a clear link between intervention focus and specific patient needs, a simple, low-effort digital interface, human-supported delivery, and device provision where needed. Although staff thought patients would lose, damage, or sell devices, reviewed studies found only 11% device loss. Barriers included intervention complexity, perceived risks, user motivation, discomfort with self-reflection, digital poverty, symptoms of psychosis, poor compatibility with existing clinical workflows, staff and patient fears that DMHIs would replace traditional face-to-face care, infrastructure limitations, and limited financial support for delivery.

CONCLUSIONS

Identified barriers and facilitators highlight key considerations for DMHI development and implementation. As to broader implications, sustainable business models are needed to ensure that evidence-based DMHIs are maintained and deployed.

TRIAL REGISTRATION

PROSPERO CRD42021282871; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282871.

[Self-help offers for people with severe mental illness: who uses which format?]

BACKGROUND

Self-help can play an important supplementary role in the treatment of people with severe mental illness; however, little is known about the utilization of the various approaches.

OBJECTIVE

This study describes the use of various self-help options by patients with severe mental illness and examines potential predictors.

MATERIAL AND METHODS

As part of the observational cross-sectional study on patients with severe mental illness (IMPPETUS, N = 397), trained staff collected sociodemographic, illness-associated and treatment-associated data between March 2019 and September 2019. Binary logistic regression was used to analyze a possible association with the use of self-help.

RESULTS

The participants most frequently reported using self-help literature (n = 170; 45.5%) followed by self-help groups (n = 130; 33.2%), electronic mental health applications (n = 56; 15.5%) and self-management approaches (n = 54; 14.8%). Trialogue seminars (n = 36; 9.9%) were the least used by the participants. The utilization of the various approaches is influenced by sociodemographic and disease-related characteristics (age, education, marital status, migration background, age at onset of initial mental health problems, psychosocial functioning level) but not by factors associated with treatment.

CONCLUSION

The potential of self-help is not being fully utilized in the sample investigated. The reported use of self-help approaches by the participants ranged between 10% and 46%. The various formats address specific target groups. More targeted information must be provided about the various options and the use of self-help in routine treatment must be actively fostered in order to increase the utilization of self-help.

Remotely Delivered Video Interaction Guidance for Families of Children With an Intellectual Disability Referred to Specialist Mental Health Services: Protocol for a Feasibility Randomized Controlled Trial

BACKGROUND

Children with an intellectual disability (ID) are 3-4 times more likely to present with behaviors that challenge and mental health problems than typically developing children. Parenting and the quality of parent-child relationships are risk factors for these families. The COVID-19 pandemic further exacerbated difficulties, leading to an increase in child mental health problems and behaviors that challenge, a deterioration in parental mental health, and further strain on family relationships. Remote family interventions could be an effective solution for both families and specialist mental health services. Video interaction guidance (VIG) has shown promise for improving child mental health. However, it is unclear whether it is widely acceptable to families and feasible to implement across specialist child mental health services.

OBJECTIVE

This randomized controlled trial aims to evaluate the feasibility of delivering VIG as a remote intervention for parents of children aged 6-12 years with ID who have been referred to specialist mental health services.

METHODS

The study will be undertaken across 5-7 National Health Service specialist mental health services in England, involving 50 participants randomly allocated on a 1:1 basis to either the intervention group (receiving remote VIG) or the treatment-as-usual (TAU) group. The intervention group will engage in 3-5 cycles of VIG delivered remotely over 12 weeks. The primary feasibility outcomes include the recruitment rate, retention at 6-month follow-up, and VIG cycle completion rate. The secondary outcomes will assess the acceptability of VIG and the feasibility of remote implementation, including fidelity to the intervention protocol. Data will be gathered through online surveys and telephone interviews at baseline, 3 months, and 6 months. Feasibility outcomes will be summarized using descriptive statistics, while thematic analysis will be applied to qualitative data from semistructured interviews with participants, VIG practitioners, and service managers. An embedded process evaluation will explore barriers and facilitators to engagement with VIG, and a parallel health economics evaluation will assess the feasibility of capturing service use data and intervention costs.

RESULTS

The trial was open to recruitment between December 2022 and March 2024. The first results should be available in 2025.

CONCLUSIONS

The study is the first randomized evaluation of VIG as offered to parents of children with ID who have been referred to specialist mental health settings. The outcomes from this feasibility trial will inform the decision to proceed with a definitive trial, using a traffic light system to evaluate recruitment, retention, and VIG completion rates alongside qualitative insights and economic evaluations.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN13171328; http://www.isrctn.com/ISRCTN13171328.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54619.

Healthcare Professionals' Views on the Use of Passive Sensing and Machine Learning Approaches in Secondary Mental Healthcare: A Qualitative Study

INTRODUCTION

Globally, many people experience mental health difficulties, and the current workforce capacity is insufficient to meet this demand, with growth not keeping pace with need. Digital devices that passively collect data and utilise machine learning to generate insights could enhance current mental health practices and help service users manage their mental health. However, little is known about mental healthcare professionals' perspectives on these approaches. This study aims to explore mental health professionals' views on using digital devices to passively collect data and apply machine learning in mental healthcare, as well as the potential barriers and facilitators to their implementation in practice.

METHODS

Qualitative semi-structured interviews were conducted with 15 multidisciplinary staff who work in secondary mental health settings. Interview topics included the use of digital devices for passive sensing, developing machine learning algorithms from this data, the clinician's role, and the barriers and facilitators to their use in practice. Interview data were analysed using reflexive thematic analysis.

RESULTS

Participants noted that digital devices for healthcare can motivate and empower users, but caution is needed to prevent feelings of abandonment and widening inequalities. Passive sensing can enhance assessment objectivity, but it raises concerns about privacy, data storage, consent and data accuracy. Machine learning algorithms may increase awareness of support needs, yet lack context, risking misdiagnosis. Barriers for service users include access, accessibility and the impact of receiving insights from passively collected data. For staff, barriers involve infrastructure and increased workload. Staff support facilitated service users' adoption of digital systems, while for staff, training, ease of use and feeling supported were key enablers.

CONCLUSIONS

Several recommendations have arisen from this study, including ensuring devices are user-friendly and equitably applied in clinical practice. Being with a blended approach to prevent service users from feeling abandoned and provide staff with training and access to technology to enhance uptake.

PATIENT OR PUBLIC CONTRIBUTION

The study design, protocol and topic guide were informed by a lived experience community group that advises on research projects at the authors' affiliation.

Social cognition interventions for patients with first-episode psychosis: A scoping review

This scoping review seeks to identify existing evidence of social cognition interventions for patients with first-episode psychosis. This review followed the five steps of Arksey and O'Malley's scoping review framework. Studies published between October 2002 and June 2023 were examined in the following six databases: PsycArticles, PsycINFO, CINAHL, EMBASE, Medline, and Scopus. We also searched grey literature and references of included studies. Studies reporting on social cognition interventions for adults with first-episode psychosis were included. Review findings were synthesised employing the PAGER framework. The PRISMA Extension for Scoping Reviews guideline was followed to prepare and report this manuscript. Twelve articles were included in this review. Most of the social cognition interventions were provided in out-patient clinics. Four studies provided board-based social cognition interventions, while the remaining eight studies introduced interventions to targeted domains of social cognition. All studies reported an improvement in patients' social functioning and social skills after receiving the intervention. Barriers and facilitators for patients with first-episode psychosis in receiving social cognition intervention were also summarised. Future studies could be conducted to explore the long-term effects of social cognition interventions, particularly for in-patient setting and the domain of social perception.

Comprehensive synthesis of mHealth interventions in psychiatry: insights from systematic, scoping, narrative reviews and content analysis

INTRODUCTION

Mobile health (mHealth) technologies, including smartphone apps and wearables, have improved health care by providing innovative solutions for monitoring, education and treatment, particularly in mental health.

METHOD

This review synthesises findings from a series of reviews on mHealth interventions in psychiatry. Publications were systematically searched in PubMed, MEDLINE, PsycINFO, ScienceDirect, Scopus, Web of Science and Cochrane Library.

RESULTS

Out of 2147 records, 111 studies from 2014 to 2024 focusing on anxiety and depression were included. These studies highlight the effectiveness of mHealth interventions in reducing symptoms through cognitive-behavioural therapy, mindfulness and psychoeducation, benefitting adolescents, perinatal women and marginalised groups. Additionally, mHealth shows promise in managing substance use disorders and severe mental illnesses like schizophrenia, bipolar disorder and psychosis.

CONCLUSION

Despite positive outcomes, challenges such as data privacy, user engagement and healthcare integration persist. Further robust trials and evidence-based research are needed to validate the efficacy of mHealth technologies.

Efficacy of User Self-Led and Human-Supported Digital Health Interventions for People With Schizophrenia: A Systematic Review and Meta-Analysis

BACKGROUND

Digital health interventions (DHIs) may enable low cost, scalable improvements in the quality of care for adults with schizophrenia. Given the fast-growing number of studies using these tools, this review aimed to assess the efficacy and feasibility of randomized controlled trials (RCTs) of DHIs among people with schizophrenia, focusing on human support.

DESIGN

A systematic search of PubMed, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane databases was conducted in January 2024 to identify relevant RCTs. Random effects meta-analyses were undertaken to evaluate the effects on psychosis symptoms, cognition, and other health-related outcomes.

RESULTS

Twenty-six RCTs (n = 2481 participants) were included. Pooled recruitment and retention rates were 57.4% and 87.6%, respectively. DHIs showed no statistically significant effect sizes across all examined outcomes, including psychosis symptoms, depression, quality of life, global and social cognition, global and social functioning, and medication adherence. A third (34.6%) of DHIs were developed using co-design while the majority (70%) personalized the intervention to its users and 69.2% were deemed to be at high risk of bias. There were trends toward effects in favor of DHIs with human support for social cognition and quality of life.

CONCLUSIONS

DHIs are feasible for people with schizophrenia and potentially useful for improving health outcomes, particularly when including human support. More high-quality studies are required to examine the benefits of human support within DHIs. Future research should examine the feasibility of sustained adherence and benefits from digital interventions, possibly incorporating human interaction complemented with artificial intelligence, in real-world clinical settings.

Stroke caregivers' perception on instant messaging application use for psychological intervention: a qualitative study

In caring for patients with stroke, the leading cause of death and disability affecting over 80 million people worldwide, caregivers experience substantial psychological and physical burdens and difficulties in help-seeking owing to physical and time-constraints. Social distancing measures imposed during the coronavirus disease 2019 (COVID-19) pandemic further restricted them from using caregiver support services. While the use of telehealth emerged as a global prevailing trend during the COVID-19 pandemic, evidence for utilising instant messaging (IM) applications for psychological intervention is scanty. This study aimed to explore stroke caregivers' perceived potential utility of IM-delivered psychological intervention. Between January and August 2020, 36 adult family stroke caregivers in Hong Kong were recruited to individual telephone semi-structured interviews using purposive sampling. The interviews were audio-recorded, transcribed verbatim and analysed using an interpretive description approach. Three themes of caregivers' perceptions towards IM-delivered psychological intervention emerged: perceived high convenience and ease of use, perceived advantages that overcome existing barriers to services and message delivery tailored to individual needs. Our findings suggested that there is an imminent need among stroke caregivers for personalised psychological interventions and that IM is a potential modality for overcoming existing barriers in delivering accessible support to caregivers in real-time, real-world settings. Our study highlighted caregivers' acceptance and perceived benefits of IM-delivered psychological intervention and provided practical insights into the design of IM-delivered psychological interventions.

People with Inflammatory Bowel Disease Prefer Cognitive Behavioral Therapy for Fatigue Management: A Conjoint Analysis

BACKGROUND

Psychological interventions are a promising area for fatigue management in patients with inflammatory bowel disease (IBD). However, most interventions trialled to date have been pilots with limited direct input from patients about the type of intervention they want. Thus, this study aimed to explore patient preferences for a psychological IBD fatigue intervention.

METHODS

An international online cross-sectional survey was conducted with adults with self-reported IBD. A conjoint analysis was employed to elicit, through a series of forced-choice scenarios, patient preferences for a fatigue intervention. For this study, the attributes manipulated across these forced-choice scenarios were type of intervention, modality of delivery, and duration of intervention.

RESULTS

Overall, 834 people with IBD were included in analysis. Respondents ranked the type of psychological intervention as most important for overall preference (with cognitive-behavioral therapy (CBT) preferred over the other approaches), followed by modality of delivery, but placed very little importance on how long the intervention runs for. Patients with IBD appear to most strongly preference a short online CBT intervention for managing their IBD-related fatigue.

CONCLUSION

This study helps provide therapists and program developers clear direction on patient preferences when it comes to developing new psychological programs that address fatigue in IBD.

Digital Lifestyle Interventions for Young People With Mental Illness: A Qualitative Study Among Mental Health Care Professionals

BACKGROUND

Given the physical health disparities associated with mental illness, targeted lifestyle interventions are required to reduce the risk of cardiometabolic disease. Integrating physical health early in mental health treatment among young people is essential for preventing physical comorbidities, reducing health disparities, managing medication side effects, and improving overall health outcomes. Digital technology is increasingly used to promote fitness, lifestyle, and physical health among the general population. However, using these interventions to promote physical health within mental health care requires a nuanced understanding of the factors that affect their adoption and implementation.

OBJECTIVE

Using a qualitative design, we explored the attitudes of mental health care professionals (MHCPs) toward digital technologies for physical health with the goal of illuminating the opportunities, development, and implementation of the effective use of digital tools for promoting healthier lifestyles in mental health care.

METHODS

Semistructured interviews were conducted with MHCPs (N=13) using reflexive thematic analysis to explore their experiences and perspectives on using digital health to promote physical health in youth mental health care settings.

RESULTS

Three overarching themes from the qualitative analysis are reported: (1) motivation will affect implementation, (2) patients' readiness and capability, and (3) reallocation of staff roles and responsibilities. The subthemes within, and supporting quotes, are described.

CONCLUSIONS

The use of digital means presents many opportunities for improving the provision of physical health interventions in mental health care settings. However, given the limited experience of many MHCPs with these technologies, formal training and additional support may improve the likelihood of implementation. Factors such as patient symptomatology, safety, and access to technology, as well as the readiness, acceptability, and capability of both MHCPs and patients to engage with digital tools, must also be considered. In addition, the potential benefits of data integration must be carefully weighed against the associated risks.

The role of sociodemographic factors on the acceptability of digital mental health care: A scoping review protocol

INTRODUCTION

Many individuals experiencing mental health complications face barriers when attempting to access services. To bridge this care gap, digital mental health innovations (DMHI) have proven to be valuable additions to in-person care by enhancing access to care. An important aspect to consider when evaluating the utility of DMHI is perceived acceptability. However, it is unclear whether diverse sociodemographic groups differ in their degree of perceived acceptability of DMHI.

OBJECTIVE

This scoping review aims to synthesize evidence on the role of sociodemographic factors (e.g., age, gender) in the perceived acceptability of DMHI among individuals seeking mental health care.

METHODS

Guided by the JBI Manual of Evidence Synthesis, chapter on Scoping Review, a search strategy developed according to the PCC framework will be implemented in MEDLINE and then adapted to four electronic databases (i.e., CINAHL, MEDLINE, PsycINFO, and EMBASE). The study selection strategy will be piloted by two reviewers on subsets of 30 articles until agreement among reviewers reaches 90%, after which one reviewer will complete the remaining screening of titles and abstracts. The full-text screening, data extraction strategy, and charting tool will be completed by one reviewer and then validated by a second member of the team. Main findings will be presented using tables and figures.

EXPECTED CONTRIBUTIONS

This scoping review will examine the extent to which sociodemographic factors have been considered in the digital mental health literature. Also, the proposed review may help determine whether certain populations have been associated with a lower level of acceptability within the context of digital mental health care. This investigation aims to favor equitable access to DMHI among diverse populations.

Acceptability and experience of a smartphone symptom monitoring app for people with psychosis in China (YouXin): a qualitative study

BACKGROUND

Access to high-quality mental healthcare remains challenging for people with psychosis globally, including China. Smartphone-based symptom monitoring has the potential to support scalable mental healthcare. However, no such tool, until now, has been developed and evaluated for people with psychosis in China. This study investigated the acceptability and the experience of using a symptom self-monitoring smartphone app (YouXin) specifically developed for people with psychosis in China.

METHODS

Semi-structured interviews were conducted with 10 participants with psychosis to explore the acceptability of YouXin. Participants were recruited from the non-randomised feasibility study that tested the validity, feasibility, acceptability and safety of the YouXin app. Data analysis was guided by the theoretical framework of acceptability.

RESULTS

Most participants felt the app was acceptable and easy to use, and no unbearable burdens or opportunity costs were reported. Participants found completing the self-monitoring app rewarding and experienced a sense of achievement. Privacy and data security were not major concerns for participants, largely due to trust in their treating hospital around data protection. Participants found the app easy to use and attributed this to the training provided at the beginning of the study. A few participants said they had built some form of relationship with the app and would miss the app when the study finished.

CONCLUSIONS

The YouXin app is acceptable for symptom self-monitoring in people with experience of psychosis in China. Participants gained greater insights about their symptoms by using the YouXin app. As we only collected retrospective acceptability in this study, future studies are warranted to assess hypothetical acceptability before the commencement of study to provide a more comprehensive understanding of implementation.

A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study

BACKGROUND

Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice.

OBJECTIVE

This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE.

METHODS

This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through "think-aloud" testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used.

RESULTS

Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals' priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users' inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy.

CONCLUSIONS

The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers.

A Mixed-Methods Implementation Evaluation of Virtual Reality Job Interview Training in IPS Supported Employment

OBJECTIVE

Employment rates among individuals with serious mental illness may be improved by engagement in the individual placement and support (IPS) model of supported employment. Results from a recent randomized controlled trial (RCT) indicate that virtual reality job interview training (VR-JIT) improves employment rates among individuals with serious mental illness who have been actively engaged in IPS for at least 90 days. This study reports on an initial implementation evaluation of VR-JIT during the RCT in a community mental health agency.

METHODS

A sequential, complementary mixed-methods design included use of qualitative data to improve understanding of quantitative findings. Thirteen IPS staff trained to lead VR-JIT implementation completed VR-JIT acceptability, appropriateness, and feasibility surveys. Participants randomly assigned to IPS with VR-JIT completed acceptability (N=42) and usability (N=28) surveys after implementation. The authors also conducted five focus groups with IPS staff (N=11) and VR-JIT recipients (N=13) and semistructured interviews with IPS staff (N=9) and VR-JIT recipients (N=4), followed by an integrated analysis process.

RESULTS

Quantitative results suggest that IPS staff found VR-JIT to be highly acceptable, appropriate for integration with IPS, and feasible for delivery. VR-JIT was highly acceptable to recipients. Qualitative results add important context to the quantitative findings, including benefits of VR-JIT for IPS staff as well as adaptations for delivering technology-based interventions to individuals with serious mental illness.

CONCLUSIONS

These qualitative and quantitative findings are consistent with each other and were influenced by VR-JIT's adaptability and perceived benefits. Tailoring VR-JIT instruction and delivery to individuals with serious mental illness may help optimize VR-JIT implementation within IPS.

Mental health services for German university students: acceptance of intervention targets and preference for delivery modes

Introduction

Most university students with mental disorders remain untreated. Evaluating the acceptance of intervention targets in mental health treatment, promotion, and prevention, as well as mental health service delivery modes is crucial for reducing potential barriers, increasing healthcare utilization, and efficiently allocating resources in healthcare services.

Aim

The study aimed to evaluate the acceptance of various intervention targets and delivery modes of mental health care services in German first-year university students.

Methods

In total, 1,376 first-year students from two German universities from the 2017-2018 multi-center cross-sectional cohort of the StudiCare project, the German arm of the World Mental Health International College Student Survey initiative, completed a web-based survey assessing their mental health. Mental disorder status was based on self-reported data fulfilling the DSM-IV criteria. We report frequencies of accepted delivery modes [categories: group or in-person therapy with on or off campus services, self-help internet- or mobile-based intervention (IMI) with or without coaching, or a combination of a in-person and IMI (blended)]. In a multinomial logistic regression, we estimate correlates of the preference for in-person vs. IMI vs. a combination of both modes (blended) modalities. Additionally, we report frequencies of intervention targets (disorder specific: e.g., social phobia, depressive mood; study-related: test anxiety, procrastination; general well-being: sleep quality, resilience) their association with mental disorders and sex, and optimal combinations of treatment targets for each mental illness.

Results

German university students' acceptance is high for in-person (71%-76%), moderate for internet- and mobile-based (45%-55%), and low for group delivery modes (31%-36%). In-person treatment (72%) was preferred over IMI (19%) and blended modalities (9%). Having a mental disorder [odds ratio (OR): 1.56], believing that digital treatments are effective (OR: 3.2), and showing no intention to use services (OR: 2.8) were associated with a preference for IMI compared to in-person modes. Students with prior treatment experience preferred in-person modes (OR: 0.46). In general, treatment targets acceptance was higher among female students and students with mental disorders. However, this was not true for targets with the highest (i.e., procrastination) and the lowest (i.e., substance-use disorder) acceptance. If only two intervention targets were offered, a combination of study-related targets (i.e., procrastination, stress, time management) would reach 85%-88% of the students.

Conclusion

In-person services are preferred, yet half of the students consider using IMI, preferably aiming for a combination of at least two study-related intervention targets. Student mental health care services should offer a combination of accepted targets in different delivery modes to maximize service utilization.

Eliciting perspectives on remote healthcare delivery from service users with psychosis in the community: a cross-sectional survey study

Introduction

The transition towards remote healthcare has been rapidly accelerated in recent years due to a number of factors, including the COVID-19 pandemic, however, few studies have explored service users' views of remote mental healthcare, particularly in community mental health settings.

Methods

As part of a larger study concerned with the development of a remotely delivered psychosocial intervention, a survey was conducted with service users with psychosis (N = 200) from six NHS trusts across England to gain cross-sectional data about service users' opinions and attitudes towards remote interventions and explore how digital access varies across different demographic groups and geographical localities.

Results

The majority of service users had access to technological devices and a quiet space to receive care. Age was a key factor in motivation to engage with remote care as older participants had less access to technological devices and the internet, and reported less confidence to learn how to use new technologies compared to younger participants. Differences in access and attitudes towards remote care were found across the different geographical localities. Over half of the participants (53.1%) preferred a hybrid model (i.e., mixture of face-to-face and remotely delivered treatment), with only 4.5% preferring remote treatment exclusively. Factors that both encourage and deter service users from engaging with remote care were identified.

Conclusions

The findings of this study provide important information about the environmental and clinical barriers that prevent, or limit, the uptake of remotely delivered care for people with psychotic disorders. Although service users often have the ability and capacity to receive remote care, providers need to be cognisant of factors which may exacerbate digital exclusion and negatively impact the therapeutic alliance.

Using digital technology to promote physical health in mental healthcare: A sequential mixed-methods study of clinicians' views

AIM

Recent years have seen innovation in 'mHealth' tools and health apps for the management/promotion of physical health and fitness across the general population. However, there is limited research on how this could be applied to mental healthcare. Therefore, we examined mental healthcare professionals' current uses and perceived roles of digital lifestyle interventions for promoting healthy lifestyles, physical health and fitness in youth mental healthcare.

METHODS

A sequential, mixed-methods design was used, consisting of a quantitative online survey, followed by qualitative in-depth interviews.

RESULTS

A total of 127 mental healthcare professionals participated in the online survey. Participants had limited mHealth experience, and the majority agreed that further training would be beneficial. Thirteen mental healthcare professionals were interviewed. Five themes were generated (i) digital technology's ability to enhance the physical healthcare; (ii) Conditions for the acceptability of apps; (iii) Limitations on staff capability and time; (iv) Motivation as the principal barrier; and (v) Practicalities around receiving lifestyle data. Systematic integration of data produced novel insights around: (i) staff involvement and needs; (ii) ideal focus and content of digital lifestyle interventions; and (iii) barriers towards implementation (including mental healthcare professionals own limited experience using digital lifestyle interventions, which aligned with the appeal of formal training).

CONCLUSIONS

Overall, digital lifestyle interventions were positively received by mental healthcare professionals, particularly for health behaviour-tracking and mHealth support for exercise and nutrition. Practical suggestions for facilitating their uptake/implementation to improve availability of physical health interventions in mental healthcare are presented.

Telehealth Collaborative Care Led by Clinical Pharmacists for People With Psychosis or Bipolar Disorder: A Propensity Weighted Comparison With Usual Psychiatric Care

Objective: People with psychosis or bipolar disorder (severe and persistent mental illness [SPMI]) are at high risk for poor psychiatric and chronic illness outcomes, which could be ameliorated through improved health care quality. This study assessed whether a telehealth, collaborative care program managed by psychiatric clinical pharmacists (SPMI Population Care) was associated with improved health care quality for adults with SPMI in a large California health system.

Methods: This retrospective cohort study used electronic health record data to compare 968 program enrollees at 6 demonstration sites (Population Care) to 8,339 contemporaneous patients with SPMI at 6 non-program sites (Usual Care). SPMI diagnoses were based on ICD-10-CM diagnostic codes. Primary outcomes were optimal psychotropic medication adherence, guideline-recommended glycemic screening, annual psychiatrist visit, and emergency department use. Difference-in-difference analyses assessed change in outcomes from 12 months pre- to 12 months post-enrollment using overlap weighting with high dimensional propensity scores to balance participant characteristics across groups. Participant data were collected from January 1, 2020, to June 30, 2022.

Results: From pre- to post-enrollment, Population Care was associated with greater achievement of psychotropic medication adherence and glycemic screening (+6 and +9 percentage points), but unexpectedly with a decrease in annual psychiatrist visits (-6 percentage points) and no significant change in emergency department use, relative to Usual Care. More than 75% of Population Care participants attended an intake and ≥ 1 follow-up visits. Participants with psychosis (26% of sample) had similar results as those with bipolar disorder.

Conclusions: Clinical pharmacist-led telehealth collaborative care has potential to improve psychopharmacologic treatment adherence and recommended disease preventive screening for people with psychosis or bipolar disorder.

Perceptions of mental health providers of the barriers and facilitators of using and engaging youth in digital mental-health-enabled measurement based care

Objectives

Increased rates of mental health disorders and substance use among youth and young adults have increased globally, furthering the strain on an already burdened mental health system. Digital solutions have been proposed as a potential option for the provision of timely mental health services for youth, with little research exploring mental health professional views about using such innovative tools. In Alberta, Canada, we are evaluating the implementation and integration of a digital mental health (dMH) platform into existing service pathways. Within this paper we seek to explore mental health professionals' perceptions of the barriers and facilitators that may influence their utilization of digital MH-enabled measurement-based care (MBC) with the youth who access their services.

Methods

A qualitative, descriptive methodology was used to inductively generate themes from focus groups conducted with mental health professionals from specialized mental health services and primary care networks in Alberta.

Results

As mental health professionals considered the barriers and facilitators of using dMH with youth, they referenced individual and family barriers and facilitators to consider. Providers highlighted perceived barriers, including: first, cultural stigma, family apprehension about mental health care, and parental access to dMH and MBC as deterrents to providers adopting digital platforms in routine care; second, perceptions of increased responsibility and liability for youth in crisis; third, perception that some psychiatric and neurodevelopmental disorders in youth are not amenable to dMH; fourth, professionals contemplated youth readiness to engage with dMH-enabled MBC. Participants also highlighted pertinent facilitators to dMH use, noting: first, the suitability of dMH for youth with mild mental health concerns; second, youth motivated to report their changes in mental health symptoms; and lastly, youth proficiency and preference for dMH options.

Conclusions

By identifying professionals' perceptions of barriers and facilitators for youth users, we may better understand how to address misconceptions about who is eligible and appropriate for dMH through training and education.

Designing Implementation Strategies for a Digital Suicide Safety Planning Intervention in a Psychiatric Emergency Department: Protocol for a Multimethod Research Project

BACKGROUND

Suicide prevention is currently a national health priority in Canada. Emergency departments (EDs) are critical settings for suicide prevention, and in our local psychiatric ED at the Centre for Addiction and Mental Health, we plan to embed an app-based tool called the Hope app to support suicide safety planning intervention. The app is free and available on app stores, and usability tests have been completed. As a next step to embed this new tool into the routine clinical workflow, research is needed to assess determinants of and design strategies for implementation with the end goal of routinization.

OBJECTIVE

The purpose of this 2-phased research is to implement the app in the routine clinical workflow in our local psychiatric ED. The specific objectives are as follows: (1) understanding ED clinicians' perceptions and experience of implementing the app in routine practice and identifying barriers to and facilitators of implementation (phase 1) and (2) using findings and outputs from phase 1 and collaborating with service users, families, and ED clinicians to co-design implementation strategies for the app (phase 2).

METHODS

We will use an integrated knowledge translation approach throughout this project. In phase 1, we will conduct interviews with ED clinicians to identify implementation determinants using a behavior change framework. In phase 2, a co-design team comprising clinicians, ED service users, and families will design implementation strategies that align with the determinants identified in phase 1.

RESULTS

This protocol presents detailed information about the entire structure of the 2-phased research project. Ethics approval for conducting the qualitative descriptive study (phase 1) has been obtained, and the recruitment and data collection processes will be completed no later than December 2023. Ethics approval for phase 2 is underway.

CONCLUSIONS

Involving multiple knowledge user groups early in the research and decision-making process is crucial for successful implementation. Although co-designing is commonly practiced during innovation development, there is often a misconception that the responsibility for implementing what has been designed falls on others. This research aims to fill this methodological gap in the health informatics literature. By the end of this project, we will have developed theory-informed implementation strategies to support Centre for Addiction and Mental Health ED clinicians in adopting the Hope app to complete safety planning intervention. These strategies, guided by a behavior change framework, will target clinicians' behavior change and seamlessly integrate the app into the routine clinical workflow. In addition, this research project will provide recommendations on how to involve multiple knowledge user groups and offer insights into how the methodology used can be adapted to other areas within the health informatics literature.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50643.

Efficacy of technology-based interventions in psychosis: a systematic review and network meta-analysis

BACKGROUND

Technology-based interventions (TBIs) are a useful approach when attempting to provide therapy to more patients with psychosis.

METHODS

Randomized controlled trials of outcomes of TBIs v. face-to-face interventions in psychosis were identified in a systematic search conducted in PubMed/Ovid MEDLINE. Data were extracted independently by two researchers, and standardized mean changes were pooled using a three-level model and network meta-analysis.

RESULTS

Fifty-eight studies were included. TBIs complementing treatment as usual (TAU) were generally superior to face-to-face interventions (g = 0.16, p ≤ 0.0001) and to specific outcomes, namely, neurocognition (g = 0.13, p ≤ 0.0001), functioning (g = 0.25, p = 0.006), and social cognition (g = 0.32, p ≤ 0.05). Based on the network meta-analysis, the effect of two TBIs differed significantly from zero; these were the TBIs cognitive training for the neurocognitive outcome [g = 0.16; 95% confidence interval (CI) 0.09-0.23] and cognitive behavioral therapy for quality of life (g = 1.27; 95% CI 0.46-2.08). The variables educational level, type of medication, frequency of the intervention, and contact during the intervention moderated the effectiveness of TBIs over face-to-face interventions in neurocognition and symptomatology.

CONCLUSIONS

TBIs are effective for the management of neurocognition, symptomatology, functioning, social cognition, and quality of life outcomes in patients with psychosis. The results of the network meta-analysis showed the efficacy of some TBIs for neurocognition, symptomatology, and quality of life. Therefore, TBIs should be considered a complement to TAU in patients with psychosis.

Assessing the acceptability of technological health innovations in sub-Saharan Africa: a scoping review and a best fit framework synthesis

Acceptability is a key concept used to analyze the introduction of a health innovation in a specific setting. However, there seems to be a lack of clarity in this notion, both conceptually and practically. In low and middle-income countries, programs to support the diffusion of new technological tools are multiplying. They face challenges and difficulties that need to be understood with an in-depth analysis of the acceptability of these innovations. We performed a scoping review to explore the theories, methods and conceptual frameworks that have been used to measure and understand the acceptability of technological health innovations in sub-Saharan Africa. The review confirmed the lack of common definitions, conceptualizations and practical tools addressing the acceptability of health innovations. To synthesize and combine evidence, both theoretically and empirically, we then used the "best fit framework synthesis" method. Based on five conceptual and theoretical frameworks from scientific literature and evidence from 33 empirical studies, we built a conceptual framework in order to understand the acceptability of technological health innovations. This framework comprises 6 determinants (compatibility, social influence, personal emotions, perceived disadvantages, perceived advantages and perceived complexity) and two moderating factors (intervention and context). This knowledge synthesis work has also enabled us to propose a chronology of the different stages of acceptability.

A cognitive-behavioural therapy programme for managing depression and anxiety in long-term physical health conditions: mixed-methods real-world evaluation of the COMPASS programme

BACKGROUND

Mental health comorbidities are common in physical long-term health conditions.

AIMS

We evaluate the effectiveness of COMPASS, a therapist-supported, digital cognitive-behavioural therapy programme specifically designed to treat anxiety/depression in the context of long-term conditions. We also investigate patient experiences of the programme.

METHOD

We utilised a mixed-methods, non-randomised design. We analysed pre-post data from 76 patients with long-term conditions who were receiving psychological treatment (COMPASS) via local NHS services, using paired sample t-tests and Cohen's d, with depression, anxiety, distress and functional impairment self-report scales. Qualitative interviews explored patients' experiences of using COMPASS. Twenty-one semi-structured interviews were completed and underwent inductive thematic analysis.

RESULTS

Patients who received COMPASS had significantly reduced depression (-2.47, 95% CI -3.7 to -1.3, P < 0.001; Cohen's d = -0.376), anxiety (-2.30, 95% CI -3.6 to -1.2, P < 0.001; Cohen's d = -0.420) and psychological distress (-4.87, 95% CI -7.0 to -2.7, P < 0.001; Cohen's d = -0.422) and significantly improved functional impairment (-3.00, 95% CI -4.8 to -1.2, P ≤ 0.001; Cohen's d = -0.282). Effect sizes were larger when analyses included only patients with clinically significant baseline symptoms: depression (-4.02, 95% CI -5.6 to -2.5, P < 0.001; Cohen's d = -0.701), anxiety (-3.60, 95% CI -5.3 to -1.9, P < 0.001; Cohen's d = -0.739), psychological distress (-5.58, 95% CI -7.9 to -3.2, P < 0.001; Cohen's d = -0.523), functional impairment (-3.28, 95% CI -5.4 to -1.1, P ≤ 0.001; Cohen's d = -0.355). Qualitative analysis yielded two meta-themes: engagement and integration of mental and physical health.

CONCLUSIONS

Results suggest that COMPASS is effective in NHS settings, and is acceptable to patients. Content tailored to long-term conditions, therapist support and clear delivery strategies should be prioritised to aid intervention implementation.

Breast Cancer Survivors' Attitudes toward eMental Health: A Cross-Sectional Study

BACKGROUND

Breast cancer survivors' (BCS) attitudes toward eMental Health (eMH) are largely unknown, and adoption predictors and their interrelationships remain unclear. This study aimed to explore BCS' attitudes toward eMH and investigate associated variables.

METHODS

A cross-sectional study involving 336 Portuguese BCS was conducted. Attitudes toward eMH, depression and anxiety symptoms, health-related quality of life, and sociodemographic, clinical, and internet-related variables were assessed using validated questionnaires. Spearman-ranked correlations, χ2, and multiple regression analyses were computed to explore associations between attitudes and collected variables.

RESULTS

BCS held a neutral stance toward eMH. In models adjusted for age and education, positive attitudes were statistically significantly associated with increased depressive symptoms and worse emotional, cognitive, and body image functioning. Social network use, online health information and mental healthcare seeking, higher self-reported knowledge of eMH, and previous use of remote healthcare were positively associated with better attitudes toward eMH.

CONCLUSIONS

eMH programs targeting BCS seem to be a promising strategy for providing supportive psychosocial care to BCS. However, increasing awareness about eMH efficacy and security may be necessary to improve its acceptance and use among BCS. Additional research is necessary to understand how BCS' unmet care needs, and specifically their psychological distress severity, may impact BCS' acceptance and use of eMH.

m-RESIST, a Mobile Therapeutic Intervention for Treatment-Resistant Schizophrenia: Feasibility, Acceptability, and Usability Study

BACKGROUND

In the European Union, around 5 million people are affected by psychotic disorders, and approximately 30%-50% of people with schizophrenia have treatment-resistant schizophrenia (TRS). Mobile health (mHealth) interventions may be effective in preventing relapses, increasing treatment adherence, and managing some of the symptoms of schizophrenia. People with schizophrenia seem willing and able to use smartphones to monitor their symptoms and engage in therapeutic interventions. mHealth studies have been performed with other clinical populations but not in populations with TRS.

OBJECTIVE

The purpose of this study was to present the 3-month prospective results of the m-RESIST intervention. This study aims to assess the feasibility, acceptability, and usability of the m-RESIST intervention and the satisfaction among patients with TRS after using this intervention.

METHODS

A prospective multicenter feasibility study without a control group was undertaken with patients with TRS. This study was performed at 3 sites: Sant Pau Hospital (Barcelona, Spain), Semmelweis University (Budapest, Hungary), and Sheba Medical Center and Gertner Institute of Epidemiology and Health Policy Research (Ramat-Gan, Israel). The m-RESIST intervention consisted of a smartwatch, a mobile app, a web-based platform, and a tailored therapeutic program. The m-RESIST intervention was delivered to patients with TRS and assisted by mental health care providers (psychiatrists and psychologists). Feasibility, usability, acceptability, and user satisfaction were measured.

RESULTS

This study was performed with 39 patients with TRS. The dropout rate was 18% (7/39), the main reasons being as follows: loss to follow-up, clinical worsening, physical discomfort of the smartwatch, and social stigma. Patients' acceptance of m-RESIST ranged from moderate to high. The m-RESIST intervention could provide better control of the illness and appropriate care, together with offering user-friendly and easy-to-use technology. In terms of user experience, patients indicated that m-RESIST enabled easier and quicker communication with clinicians and made them feel more protected and safer. Patients' satisfaction was generally good: 78% (25/32) considered the quality of service as good or excellent, 84% (27/32) reported that they would use it again, and 94% (30/32) reported that they were mostly satisfied.

CONCLUSIONS

The m-RESIST project has provided the basis for a new modular program based on novel technology: the m-RESIST intervention. This program was well-accepted by patients in terms of acceptability, usability, and satisfaction. Our results offer an encouraging starting point regarding mHealth technologies for patients with TRS.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03064776; https://clinicaltrials.gov/ct2/show/record/NCT03064776.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2017-021346.

Exploring engagement with the CBT-informed Actissist smartphone application for early psychosis

BACKGROUND

Individuals with psychosis report favourable attitudes towards psychological interventions delivered via smartphone apps. Evidence for acceptability, safety, feasibility and efficacy is promising but in-depth reporting of app engagement in trials is sparse.

AIMS

To examine how people with psychosis engaged with the cognitive behaviour therapy (CBT)-informed Actissist app over a 12-week intervention period, and to examine factors associated with app engagement.

METHODS

Secondary data from participants in the intervention arm (n = 24) of a proof-of-concept randomised controlled trial of the Actissist app were analysed. The app prompted participants to engage with app-based CBT-informed material in five domains (voices, socialization, cannabis use, paranoia, perceived criticism) at pseudo-random intervals (three notifications per day, six days per week). Participants could self-initiate use any time. App use was financially incentivised.

RESULTS

Participants responded to 47% of app notifications. Most app engagements (87%) were app-initiated rather than self-initiated. Participants engaged most with the voices domain, then paranoia. Age and employment status were significantly associated with overall app engagement.

CONCLUSION

Individuals with psychosis engaged well with Actissist, particularly with areas focussing on voice-hearing and paranoia. App-generated reminders successfully prompted app engagement. As financial incentives may have increased app engagement, future studies of non-incentivized engagement in larger samples are needed.

A Web-Based Stratified Stepped Care Platform for Mental Well-being (TourHeart+): User-Centered Research and Design

BACKGROUND

Internet-based mental health interventions have been demonstrated to be effective in alleviating psychological distress and promoting mental well-being. However, real-world uptake and engagement of such interventions have been low. Rather than being stand-alone interventions, situating internet-based interventions under a stratified stepped care system can support users to continue with mental health practice and monitor their mental health status for timely services that are commensurate with their needs. A user-centered approach should be used in the development of such web-based platforms to understand the facilitators and barriers in user engagement to enhance platform uptake, usability, and adherence so it can support the users' continued adoption and practice of self-care for their mental health.

OBJECTIVE

The aim of this study was to describe the design process taken to develop a web-based stratified stepped care mental health platform, TourHeart+, using a user-centered approach that gathers target users' perceptions on mental self-care and feedback on the platform design and incorporates them into the design.

METHODS

The process involved a design workshop with the interdisciplinary development team, user interviews, and 2 usability testing sessions on the flow of registration and mental health assessment and the web-based self-help interventions of the platform. The data collected were summarized as descriptive statistics if appropriate and insights are extracted inductively. Qualitative data were extracted using a thematic coding approach.

RESULTS

In the design workshop, the team generated empathy maps and point-of-view statements related to the possible mental health needs of target users. Four user personas and related processes in the mental health self-care journey were developed based on user interviews. Design considerations were derived based on the insights drawn from the personas and mental health self-care journey. Survey results from 104 users during usability testing showed that the overall experience during registration and mental health assessment was friendly, and they felt cared for, although no statistically significant differences on preference ratings were found between using a web-based questionnaire tool and through an interactive chatbot, except that chatbot format was deemed more interesting. Facilitators of and barriers to registering the platform and completing the mental health assessment were identified through user feedback during simulation with mock-ups. In the usability testing for guided self-help interventions, users expressed pain points in course adherence, and corresponding amendments were made in the flow and design of the web-based courses.

CONCLUSIONS

The design process and findings presented in the study are important in developing a user-centric platform to optimize users' acceptance and usability of a web-based stratified stepped care platform with guided self-help interventions for mental well-being. Accounting for users' perceptions and needs toward mental health self-care and their experiences in the design process can enhance the usability of an evidence-based mental health platform on the web.

Use of digital technologies by users of psychiatric inpatient services in Berlin, Germany: a cross-sectional patient survey

Few studies and almost exclusively from the USA have recently investigated mobile phone and computer use among users of psychiatric services, which is of high relevance regarding the increasing development of digital health applications and services.

OBJECTIVE, DESIGN AND SETTING

In a cross-sectional patient survey, we examined (a) rates and purposes of mobile phone, computer, internet and social media use, and (b) the role of social and clinical predictors on rates of utilisation among psychiatric inpatients in Berlin, Germany.

PARTICIPANTS AND RESULTS

Descriptive analyses showed that among 496 participants, 84.9% owned a mobile phone and 59.3% a smartphone. Among 493 participants, 68.4% used a computer regularly. Multivariate logistic regression models revealed being homeless, diagnosis of a psychotic illness, being of older age and a lower level of education to be significant predictors for not owning a mobile phone, not using a computer regularly or having a social media account, respectively.

CONCLUSIONS

Users of psychiatric services may have access to mobile phones and computers, although rates are lower than in the general population. However, key barriers that need to be addressed regarding the development of and engagement with digital health interventions are factors of social exclusion like marginalised housing as well as clinical aspects like psychotic illness.

Providing Human Support for the Use of Digital Mental Health Interventions: Systematic Meta-review

BACKGROUND

Digital mental health interventions (DMHIs) have been increasingly deployed to bridge gaps in mental health care, particularly given their promising efficacy. Nevertheless, attrition among DMHI users remains high. In response, human support has been studied as a means of improving retention to and outcomes of DMHIs. Although a growing number of studies and meta-analyses have investigated the effects of human support for DMHIs on mental health outcomes, systematic empirical evidence of its effectiveness across mental health domains remains scant.

OBJECTIVE

We aimed to summarize the results of meta-analyses of human support versus no support for DMHI use across various outcome domains, participant samples, and support providers.

METHODS

We conducted a systematic meta-review of meta-analyses, comparing the effects of human support with those of no support for DMHI use, with the goal of qualitatively summarizing data across various outcome domains, participant samples, and support providers. We used MEDLINE, PubMed, and PsycINFO electronic databases. Articles were included if the study had a quantitative meta-analysis study design; the intervention targeted mental health symptoms and was delivered via a technology platform (excluding person-delivered interventions mediated through telehealth, text messages, or social media); the outcome variables included mental health symptoms such as anxiety, depression, stress, posttraumatic stress disorder symptoms, or a number of these symptoms together; and the study included quantitative comparisons of outcomes in which human support versus those when no or minimal human support was provided.

RESULTS

The results of 31 meta-analyses (505 unique primary studies) were analyzed. The meta-analyses reported 45 effect sizes; almost half (n=22, 48%) of them showed that human-supported DMHIs were significantly more effective than unsupported DMHIs. A total of 9% (4/45) of effect sizes showed that unsupported DMHIs were significantly more effective. No clear patterns of results emerged regarding the efficacy of human support for the outcomes assessed (including anxiety, depression, posttraumatic stress disorder, stress, and multiple outcomes). Human-supported DMHIs may be more effective than unsupported DMHIs for individuals with elevated mental health symptoms. There were no clear results regarding the type of training for those providing support.

CONCLUSIONS

Our findings highlight the potential of human support in improving the effects of DMHIs. Specifically, evidence emerged for stronger effects of human support for individuals with greater symptom severity. There was considerable heterogeneity across meta-analyses in the level of detail regarding the nature of the interventions, population served, and support delivered, making it difficult to draw strong conclusions regarding the circumstances under which human support is most effective. Future research should emphasize reporting detailed descriptions of sample and intervention characteristics and describe the mechanism through which they believe the coach will be most useful for the DMHI.

The effectiveness and design of informed choice tools for people with severe mental illness: a systematic review

BACKGROUND

People with severe mental illness (SMI) report difficulty in making health-related decisions. Informed choice tools are designed to guide individuals through a decision-making process.

AIMS

To determine the effectiveness of these tools for people with SMI and to identify what methods and processes may contribute to effectiveness.

METHOD

A systematic electronic search was conducted for studies published between 1996 and January 2018. The search was updated in March 2020. Studies of any design reporting the development or evaluation of any informed choice tool for people with SMI were considered. A structured, narrative synthesis was conducted.

RESULTS

Ten articles describing four tools were identified. Tools were designed to assist with decision-making around bipolar treatment, smoking cessation and disclosure of mental illness in employment situations. Positive changes in decisional conflict, stage of change, knowledge and self-efficacy were reported for two tools, though insufficient data exists for definitive conclusions of effectiveness. Feedback from service users and attention to readability appeared key.

CONCLUSIONS

The evidence base for informed choice tools for people with SMI is limited. Such tools should be developed in stages and include the views of people with SMI at each phase; readability should be considered, and a theoretical framework should be used to facilitate process evaluation.

Personalised digital technology for mental health in the armed forces: the potential, the hype and the dangers

The COVID-19 pandemic has resulted in a digital technology revolution which included widespread use in remote healthcare settings, remote working and use of technology to support friends and family to stay in touch. The armed forces have also increased its use of digital technology, but not at the same rate, and it is important that they do not fall behind in the revolution. One area where digital technology could be helpful is the treatment and management of mental health conditions. In a civilian setting, digital technology adoption has been found to be acceptable and feasible yet there is little use in the armed forces. In this personal view, we explore the potential use of personalised digital technology for mental health, the hype surrounding it and the dangers.This paper forms part of the special issue of BMJ Military Health dedicated to personalised digital technology for mental health in the armed forces.

Biopsychology of Physical Activity in People with Schizophrenia: An Integrative Perspective on Barriers and Intervention Strategies

People with severe mental illness such as schizophrenia experience high physical comorbidity, leading to a 15-20-year mortality gap compared with the general population. Lifestyle behaviours such as physical activity (PA) play important roles in the quest to bridge this gap. Interventions to increase PA engagement in this population have potential to be efficacious; however, their effectiveness can be hindered by low participant engagement, including low adherence and high drop-out, and by implementation of interventions that are not designed to compensate for the cognitive and motivational impairments characteristic for this group. Moreover, and importantly, the negative symptoms of schizophrenia are associated with neurobiological changes in the brain, which-based on principles of biopsychology-can contribute to poor motivation and impaired decision-making processes and behavioural maintenance. To increase PA levels in people with schizophrenia, better understanding of these neurological changes that impact PA engagement is needed. This has the potential to inform the design of interventions that, through enhancement of motivation, could effectively increase PA levels in this specific population. Incorporating strategies that address the dopamine dysregulation associated with schizophrenia, such as boosting the role of reward and self-determined motivation, may improve long-term PA maintenance, leading to habitual PA. Consideration of motivation and behavioural maintenance is also needed to impart health benefits such as prevention of chronic disease, which is associated with currently low PA levels in this high metabolic risk population. Taking a biopsychological perspective, we outline the neural pathways involved in motivation that are impacted by schizophrenia and propose strategies for promoting motivation for and PA engagement from adoption to habit formation.

Digital health experiences reported in chronic disease management: An umbrella review of qualitative studies

INTRODUCTION

Digital health interventions can be useful for the management of chronic disease. The aim of this study was to draw out universal themes to understand how people with chronic conditions experience digital health services, programmes, and interventions, and consequently, better inform future digital health delivery.

METHODS

An umbrella review was conducted to identify qualitative systematic reviews reporting digital health experiences in chronic disease. Themes for each included review were independently extracted and appraised by two review authors. Data analysis was conducted using the Constant Comparative method.

RESULTS

Twenty-two systematic reviews containing 240 individual studies were selected for inclusion. Mental health was the most common condition (n = 5, 23%), followed by cancer (n = 4, 18%) or a combination of chronic diseases (n = 4, 18%). Common themes across the conditions were categorised under nine headings, including: (i) participation and engagement (strong usability and engagement vs reluctance to use digital health when these concepts are ignored), (ii) trust, confidence, and competence (users felt reassured, however technology illiteracy led to a perceived lack of control), (iii) perceived value, perceived effectiveness, transaction cost (gained from efficient aspects of digital health, but also lost through the burden of keeping up with data entry), (iv) perceived care quality (requiring tailoring and fostering motivation), (v) barriers and threats (related to technology risks and challenges), (vi) health outcomes (improved self-management capability), (vii) relationships (improved participant-health professional interaction, but interpersonal aspects such as face-to-face contact were lacking), (viii) unplanned benefit (where digital health often led to users feeling more empowered in their health journey), and (ix) diversity of experiences (reflecting ambivalence of experiences and discipline-specific experiences).

CONCLUSION

People with chronic conditions perceive digital health provides feelings of reassurance and the ability to self-manage their condition. While there is ambivalence across the participant experiences reported within the major themes, this umbrella review has outlined a need for future interventions that are user-friendly, flexible, and tailored to individual users. This will be best achieved through a co-design model, with the consumer actively involved in the planning and design of digital health products and services.

Can behavior change techniques be delivered via short text messages?

Despite significant advancements in behavioral science it is unclear whether behavior change techniques (or BCTs) can be delivered to large numbers of people in a cost-effective and reliable way. The current study investigated whether it is possible to reliably deliver BCTs using short text messages. Short text messages were designed to deliver each of the 93 BCTs specified in the BCT taxonomy v1. Following initial coding and refinement by the team, a Delphi study with a panel of 15 experts coded which BCT each short text message was designed to deliver and also rated whether they were likely to be understood by recipients and easily converted to target different behaviors. After two iterations, the experts correctly assigned 66 of the 93 messages to the BCT that they were designed to deliver and indicated that these messages were likely to be easy to apply to a range of behaviors and understood by recipients. Experts were not able to identify which BCT 27 of the messages were designed to deliver and it was notable that some clusters of BCTs (e.g., "Goals and planning") were easier to deliver via short text messages than other clusters (e.g., "Scheduled consequences"). The findings suggest that short text messages can be a reliable way to deliver many, but not all, BCTs. The implications of the current study are discussed with respect to the delivery of specific BCTs and clusters of the taxonomy, as well as the need to test the acceptability of interventions delivered via short messages and the impact of messages on behavior.

Exploring the acceptability of a brief online theory-based intervention to prevent and reduce self-harm: a theoretically framed qualitative study

BACKGROUND

The volitional help sheet for self-harm equips people with the means of responding automatically to triggers for self-harm with coping strategies. Improving acceptability may be crucial to increasing effectiveness and reach. The Theoretical Framework of Acceptability (TFA) was developed to guide the assessment of intervention acceptability, but to date, no studies have applied the TFA to understand acceptability of interventions for self-harm.

AIMS

To apply the TFA to (a) explore people's experiences of a brief intervention to reduce repeat self-harm; and (b) understand the most prominent aspects of intervention acceptability, to make recommendations for intervention refinements and successful implementation.

METHOD

Sixteen semi-structured interviews were conducted with people who had previously self-harmed. The TFA informed a framework analysis in which findings were mapped onto the TFA.

RESULTS

Four TFA domains were identified that were associated with acceptability of the volitional help sheet for self-harm: affective attitude, burden, intervention coherence and perceived effectiveness. People were generally positive about using the volitional help sheet (affective attitude), understood the volitional help sheet and how it worked (intervention coherence), highlighted engagement as a motivating factor in using the volitional help sheet (perceived burden) and described how the volitional help sheet could be implemented by healthcare professionals (perceived effectiveness).

CONCLUSIONS

Further modifications could still be made, but it is hoped that this intervention provides a useful tool for individuals to construct their own personalised implementation intentions, and as part of longer-term support for preventing self-harm as delivered by healthcare professionals.

Systematic Literature Review of Text Messaging Interventions to Promote Medication Adherence Among People With Serious Mental Illness

OBJECTIVE

Mobile health tools are feasible options to encourage behavior change among patients with serious mental illness. Mobile health tools vary widely, both in platforms used and content delivered. This literature review assessed the use of text messaging interventions to promote medication adherence among patients with serious mental illness.

METHODS

A systematic literature review using PRISMA guidelines examined short message service (SMS) text messaging interventions promoting medication adherence to people with a serious mental illness diagnosis. Databases included PubMed, Cochrane, CINAHL, and PsycINFO. Data extraction included demographic information, participant diagnoses, intervention components, medication class, adherence measures, research design, and study outcomes. Study quality was also assessed.

RESULTS

Of 114 full-text articles screened, 10 articles were selected from nine unique interventions (N=937 people with serious mental illness). Study durations ranged from 30 days to 18 months, with frequency of SMS ranging from twice weekly to 12 times daily. Of the nine unique trials, most reported using an automated server to deliver SMS messages (N=7), two-way SMS capabilities (N=6), customized message content or timing (N=7), and additional components (e.g., provider contact, educational content, and monetary rewards) (N=7). Seven of the 10 articles reported statistically significant improvement in medication adherence and in at least one clinical outcome.

CONCLUSIONS

Evidence to date indicates that text messaging interventions are feasible and appear to improve medication adherence and clinical outcomes among patients with serious mental illness. Future research should assess implementation approaches and how to scale up efforts in nonresearch settings.

Mental health professionals views and the impact of COVID-19 pandemic on implementing digital mental health in China: A nationwide survey study

BACKGROUND

Using digital health technologies (DHTs) to deliver and augment healthcare is an innovative way to solve common challenges that the mental healthcare setting faces. Despite China's rapid development of DHT, a comprehensive understanding of staff views of DHTs is lacking, which limited the evidence to support implementation strategies. In the current study, we aim to: (i) investigate staff attitudes towards digital technology for mental health problems in China; (ii) explore staff's views on the facilitators and barriers regarding uptake and adoption of digital technology in mental health services in China; and (iii) understand how the COVID-19 pandemic has changed staff views on digital mental health.

METHODS

An online survey was conducted to explore staff attitudes towards implementing DHTs in China. Descriptive statistics were conducted to summarise quantitative data. Free-text data were analysed using qualitative content analysis.

RESULTS

1270 mental health professionals completed the survey. Respondents reported low levels of knowledge of DHTs and moderate levels of accessibility of DHTs in their hospitals. Respondents expressed positive attitudes towards DHTs and demonstrated moderate levels of perceived feasibility and acceptability of implementing DHTs in clinical services. As expected, respondents reported that the COVID-19 pandemic caused significant impacts on their clinical services, and almost all respondents deemed DHTs useful for services provision during the pandemic and were willing to apply such technologies in clinical services after the pandemic.

CONCLUSIONS

Despite the Chinese mental health staff expressed positive attitudes towards implementing DHTs in clinical practice, most of the staff lacked sufficient knowledge to provide such services. These findings highlight the need to develop implementation strategies such as training programmes and dissemination of research evidence to support the translation of research.

The service user experience of SlowMo therapy: A co-produced thematic analysis of service users' subjective experience

OBJECTIVES

SlowMo is the first blended digital therapy for paranoia, showing significant small-moderate reductions in paranoia in a recent large-scale randomized controlled trial (RCT). This study explored the subjective service-user experience of the SlowMo therapy content and design; the experience of the blended therapy approach, including the triangle of the therapeutic alliance; and the experience of the digital aspects of the intervention.

DESIGN

Qualitative co-produced sub-study of an RCT.

METHODS

Participants were 22 adult service users with schizophrenia-spectrum psychosis and persistent distressing paranoia, who completed at least one SlowMo therapy session and a 24-week follow-up, at one of 3 sites in Oxford, London, and Sussex, UK. They were interviewed by peer researchers, using a topic guide co-produced by the Patient and Public Involvement (PPI) team. The transcribed data were analysed thematically. Multiple coding and triangulation, and lay peer researcher validation were used to reach a consensus on the final theme structure.

RESULTS

Six core themes were identified: (i) starting the SlowMo journey; (ii) the central role of the supportive therapist; (iii) slowing things down; (iv) value and learning from social connections; (v) approaches and challenges of technology; and (vi) improvements in paranoia and well-being.

CONCLUSIONS

For these service users, slowing down for a moment was helpful, and integrated into thinking over time. Learning from social connections reflected reduced isolation, and enhanced learning through videos, vignettes, and peers. The central role of the supportive therapist and the triangle of alliance between service user, therapist, and digital platform were effective in promoting positive therapeutic outcomes.

Usage Patterns of Telepsychology and Face-to-Face Psychotherapy: Clients' Profiles and Perceptions

Background

Currently, most people who might need mental health care services do not receive them due to a number of reasons. Many of these reasons can be overcome by telepsychology, in other words, the use of ICT technologies for therapy (e.g., phone, videoconferencing, and apps); given that it facilitates access to specialized interventions. In fact, telepsychology is currently offered as an active service in many psychotherapy centers. However, its usage, how it is perceived, and who uses it are still largely unknown.

Objective

The aim of this study was (1) to determine if any pattern exists in the usage of telepsychology and face-to-face psychology, (2) to clarify people's perception of telepsychology in terms of the advantages, barriers and efficacy of online psychotherapy, and (3) to examine usage patterns in terms of individual characteristics and identify patients' profiles.

Methods

An online survey was conducted on a convenience sample of 514 subjects recluted by using an online advertisement. The inclusion criteria were: (1) to be older than 18 years old and (2) to answer completely the questionnaire. Cluster analysis, ANOVAs, and discriminant analysis were performed to test our research objectives.

Results

Three usage clusters were found: (1) face-to-face psychotherapy (57%; n = 292); (2) non-therapy (36.8%; n = 189); and (3) combined face-to-face psychotherapy and telepsychology (6.4%; n = 33). In addition, the perception of telepsychology varied among usage clusters, but a common perception emerged about the main telepsychology advantages, barriers and efficacy. Finally, the results showed that personal characteristics differentiated people in each of these clusters.

Conclusion

The most common form of access to psychotherapy is the face-to-face form but the second way of delivery was a combination between face to face and online psychotherapy (research objective 1). People who combine face to face with online psychotherapy perceives this last as more efficient and with less barriers to access (research objective 2). Finally, some characteristic as eHealth experience and sociodemographic variables can help to identify people that will attend telepsychology initiatives (research objective 3). These clusters provide insight into opportunities for face-to-face and online patient engagement strategies.

Telepsychiatry services during COVID-19: A cross-sectional survey on the experiences and perspectives of young adults with first-episode psychosis

INTRODUCTION

Limited evidence exists on the implementation of telepsychiatry within the context of early intervention services for psychosis, the need for which has become even more relevant during the COVID-19 pandemic. To address this gap, we investigated the experiences and perspectives of young adults recovering from a first-episode psychosis (FEP) following their use of telepsychiatry services (i.e. use of video conferencing technology to deliver mental health services to patients in real time).

METHODS

A cross-sectional online survey study was implemented between November 19^th , 2020 and March 9^th , 2021 with young adults recruited from a specialized program for FEP located in an urban Canadian setting. Data were analysed using descriptive statistics, exploratory (Fisher's exact test), and content analysis.

RESULTS

Among 51 participants (mean age = 26.0, SD = 4.7; 56.9% female), the majority were satisfied with the service (91%, 46/51), perceived that the platform was easy to use (90%, 46/51) and felt secure in terms of confidentiality (82%, 42/51). Satisfaction was related to perceptions regarding ease of use, image quality, and employment/studying status. Several partially or totally agreed that the presence of a third party was essential to login during the first few sessions (35%, 18/51), and some needed technical support (24%, 12/51) throughout the sessions.

CONCLUSIONS

This study shows that telepsychiatry is feasible and acceptable to implement for patients in the early phase of psychosis recovery. It also highlights the importance of making technical support available, especially in the first few times of using the service, and addressing patient concerns regarding confidentiality, even when using secured health technologies.

Workplace interventions to prevent or reduce post-traumatic stress disorder and symptoms among hospital nurses: A scoping review

OBJECTIVES

The aim of this study was to identify literature on evaluated workplace interventions to prevent or reduce the prevalence or impact of work-related post-traumatic stress disorder (PTSD) and PTSD symptoms among hospital nurses. A second objective was to summarise and compare the characteristics and effectiveness of these interventions.

BACKGROUND

A substantial proportion of nurses report PTSD symptoms. Previous reviews have synthesised interventions to address PTSD in military and other high-risk populations, but similar work focusing on nurses has yet to be conducted.

METHODS

We conducted a scoping review with the question: What interventions have been studied to prevent or treat PTSD symptoms or PTSD among nurses working in hospitals? We followed the PRISMA Scoping Review Checklist using an unregistered protocol. We searched in twelve academic and grey literature databases (e.g. MedLine, CINAHL) with no language restrictions. We included publications reporting on interventions which were evaluated for measurable impacts on PTSD and PTSD symptoms among nursing staff working in inpatient settings from 1980 to 2019, and charted study characteristics in a spreadsheet.

RESULTS

From 7746 results, 63 studies moved to full-text screening, and six studies met inclusion criteria. Methodologies included three randomised controlled studies, one quasi-experimental study, one pre-post feasibility study and one descriptive correlational study. Four studies reported a significant reduction in PTSD scores in intervention groups compared with baseline or comparison, when using debriefing, guided imagery or mindfulness-based exercises.

CONCLUSIONS

This review identified six studies evaluating hospital-based interventions to reduce PTSD and PTSD symptoms among hospital nurses, with some positive effects reported, contributing to a preliminary evidence base on reducing workplace trauma. Larger studies can compare nurse subpopulations, and system-level interventions should expand the focus from individuals to organisations.

RELEVANCE TO CLINICAL PRACTICE

This review can inform nursing and hospital leaders developing evidence-based interventions for PTSD among nurses.

Acceptability of Web-Based Mental Health Interventions in the Workplace: Systematic Review

BACKGROUND

Web-based interventions have proven to be effective not only in clinical populations but also in the occupational setting. Recent studies conducted in the work environment have focused on the effectiveness of these interventions. However, the role of employees' acceptability of web-based interventions and programs has not yet enjoyed a similar level of attention.

OBJECTIVE

The objective of this systematic review was to conduct the first comprehensive study on employees' level of acceptability of web-based mental health interventions based on direct and indirect measures, outline the utility of different types of web-based interventions for work-related mental health issues, and build a research base in the field.

METHODS

The search was conducted between October 2018 and July 2019 and allowed for any study design. The studies used either qualitative or quantitative data sources. The web-based interventions were generally aimed at supporting employees with their mental health issues. The study characteristics were outlined in a table as well as graded based on their quality using a traffic light schema. The level of acceptability was individually rated using commonly applied methods, including percentile quartiles ranging from low to very high.

RESULTS

A total of 1303 studies were identified through multiple database searches and additional resources, from which 28 (2%) were rated as eligible for the synthesis. The results of employees' acceptability levels were mixed, and the studies were very heterogeneous in design, intervention characteristics, and population. Approximately 79% (22/28) of the studies outlined acceptability measures from high to very high, and 54% (15/28) of the studies reported acceptability levels from low to moderate (overlap when studies reported both quantitative and qualitative results). Qualitative studies also provided insights into barriers and preferences, including simple and tailored application tools as well as the preference for nonstigmatized language. However, there were multiple flaws in the methodology of the studies, such as the blinding of participants and personnel.

CONCLUSIONS

The results outline the need for further research with more homogeneous acceptability studies to draw a final conclusion. However, the underlying results show that there is a tendency toward general acceptability of web-based interventions in the workplace, with findings of general applicability to the use of web-based mental health interventions.

Characterizing Use of a Multicomponent Digital Intervention to Predict Treatment Outcomes in First-Episode Psychosis: Cluster Analysis

BACKGROUND

Multicomponent digital interventions offer the potential for tailored and flexible interventions that aim to address high attrition rates and increase engagement, an area of concern in digital mental health. However, increased flexibility in use makes it difficult to determine which components lead to improved treatment outcomes.

OBJECTIVE

This study aims to identify user profiles on Horyzons, an 18-month digital relapse prevention intervention for first-episode psychosis that incorporates therapeutic content and social networking, along with clinical, vocational, and peer support, and to examine the predictive value of these user profiles for treatment outcomes. A secondary objective is to compare each user profile with young people receiving treatment as usual (TAU).

METHODS

Participants comprised 82 young people (aged 16-27 years) with access to Horyzons and 84 receiving TAU, recovering from first-episode psychosis. In addition, 6-month use data from the therapy and social networking components of Horyzons were used as features for K-means clustering for joint trajectories to identify user profiles. Social functioning, psychotic symptoms, depression, and anxiety were assessed at baseline and 6-month follow-up. General linear mixed models were used to examine the predictive value of user profiles for treatment outcomes and between each user profile with TAU.

RESULTS

A total of 3 user profiles were identified based on the following system use metrics: low use, maintained use of social components, and maintained use of both therapy and social components. The maintained therapy and social group showed improvements in social functioning (F_2,51=3.58; P=.04), negative symptoms (F_2,51=4.45; P=.02), and overall psychiatric symptom severity (F_2,50=3.23; P=.048) compared with the other user profiles. This group also showed improvements in social functioning (F_1,62=4.68; P=.03), negative symptoms (F_1,62=14.61; P<.001), and overall psychiatric symptom severity (F_1,63=5.66; P=.02) compared with the TAU group. Conversely, the maintained social group showed increases in anxiety compared with the TAU group (F_1,57=7.65; P=.008). No differences were found between the low use group and the TAU group on treatment outcomes.

CONCLUSIONS

Continued engagement with both therapy and social components might be key in achieving long-term recovery. Maintained social use and low use outcomes were broadly comparable with TAU, emphasizing the importance of maintaining engagement for improved treatment outcomes. Although the social network may be a key ingredient to increase sustained engagement, as users engaged with this more consistently, it should be leveraged as a tool to engage young people with therapeutic content to bring about social and clinical benefits.