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Potts C, Lindström F, Bond R, Mulvenna M, Booth F, Ennis E, Parding K, Kostenius C, Broderick T, Boyd K, Vartiainen AK, Nieminen H, Burns C, Bickerdike A, Kuosmanen L, Dhanapala I, Vakaloudis A, Cahill B, MacInnes M, Malcolm M, O'Neill S. A Multilingual Digital Mental Health and Well-Being Chatbot (ChatPal): Pre-Post Multicenter Intervention Study. J Med Internet Res 2023; 25:e43051. [PMID: 37410537 PMCID: PMC10359914 DOI: 10.2196/43051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/30/2022] [Accepted: 01/31/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In recent years, advances in technology have led to an influx of mental health apps, in particular the development of mental health and well-being chatbots, which have already shown promise in terms of their efficacy, availability, and accessibility. The ChatPal chatbot was developed to promote positive mental well-being among citizens living in rural areas. ChatPal is a multilingual chatbot, available in English, Scottish Gaelic, Swedish, and Finnish, containing psychoeducational content and exercises such as mindfulness and breathing, mood logging, gratitude, and thought diaries. OBJECTIVE The primary objective of this study is to evaluate a multilingual mental health and well-being chatbot (ChatPal) to establish if it has an effect on mental well-being. Secondary objectives include investigating the characteristics of individuals that showed improvements in well-being along with those with worsening well-being and applying thematic analysis to user feedback. METHODS A pre-post intervention study was conducted where participants were recruited to use the intervention (ChatPal) for a 12-week period. Recruitment took place across 5 regions: Northern Ireland, Scotland, the Republic of Ireland, Sweden, and Finland. Outcome measures included the Short Warwick-Edinburgh Mental Well-Being Scale, the World Health Organization-Five Well-Being Index, and the Satisfaction with Life Scale, which were evaluated at baseline, midpoint, and end point. Written feedback was collected from participants and subjected to qualitative analysis to identify themes. RESULTS A total of 348 people were recruited to the study (n=254, 73% female; n=94, 27% male) aged between 18 and 73 (mean 30) years. The well-being scores of participants improved from baseline to midpoint and from baseline to end point; however, improvement in scores was not statistically significant on the Short Warwick-Edinburgh Mental Well-Being Scale (P=.42), the World Health Organization-Five Well-Being Index (P=.52), or the Satisfaction With Life Scale (P=.81). Individuals that had improved well-being scores (n=16) interacted more with the chatbot and were significantly younger compared to those whose well-being declined over the study (P=.03). Three themes were identified from user feedback, including "positive experiences," "mixed or neutral experiences," and "negative experiences." Positive experiences included enjoying exercises provided by the chatbot, while most of the mixed, neutral, or negative experiences mentioned liking the chatbot overall, but there were some barriers, such as technical or performance errors, that needed to be overcome. CONCLUSIONS Marginal improvements in mental well-being were seen in those who used ChatPal, albeit nonsignificant. We propose that the chatbot could be used along with other service offerings to complement different digital or face-to-face services, although further research should be carried out to confirm the effectiveness of this approach. Nonetheless, this paper highlights the need for blended service offerings in mental health care.
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Affiliation(s)
- Courtney Potts
- School of Psychology, Ulster University, Coleraine, United Kingdom
| | - Frida Lindström
- Department of Social Sciences,Technology and Arts, Luleå University of Technology, Luleå, Sweden
| | - Raymond Bond
- School of Computing, Ulster University, Belfast, United Kingdom
| | | | - Frederick Booth
- Department of Accounting, Finance & Economics, Ulster University, Belfast, United Kingdom
| | - Edel Ennis
- School of Psychology, Ulster University, Coleraine, United Kingdom
| | - Karolina Parding
- Department of Social Sciences,Technology and Arts, Luleå University of Technology, Luleå, Sweden
| | - Catrine Kostenius
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Thomas Broderick
- Department of Sport, Leisure & Childhood Studies, Munster Technological University, Cork, Ireland
| | - Kyle Boyd
- School of Art, Ulster University, Belfast, United Kingdom
| | - Anna-Kaisa Vartiainen
- Department of Social and Health Management, University of Eastern Finland, Kuopio, Finland
| | - Heidi Nieminen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Con Burns
- Department of Sport, Leisure & Childhood Studies, Munster Technological University, Cork, Ireland
| | - Andrea Bickerdike
- Department of Sport, Leisure & Childhood Studies, Munster Technological University, Cork, Ireland
| | - Lauri Kuosmanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Indika Dhanapala
- Nimbus Research Centre, Munster Technological University, Cork, Ireland
| | - Alex Vakaloudis
- Nimbus Research Centre, Munster Technological University, Cork, Ireland
| | - Brian Cahill
- Nimbus Research Centre, Munster Technological University, Cork, Ireland
| | - Marion MacInnes
- Research & Innovation, National Health Service Western Isles, Scotland, United Kingdom
| | - Martin Malcolm
- Public Health Intelligence and Information Services, National Health Service Western Isles, Scotland, United Kingdom
| | - Siobhan O'Neill
- School of Psychology, Ulster University, Coleraine, United Kingdom
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Zubala A, Kennell N, MacInnes C, MacInnes M, Malcolm M. Online art therapy pilot in the Western Isles of Scotland: a feasibility and acceptability study of a novel service in a rural community. Front Psychiatry 2023; 14:1193445. [PMID: 37283707 PMCID: PMC10241303 DOI: 10.3389/fpsyt.2023.1193445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/27/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Art therapy, despite being an evidence-based, safe and acceptable intervention, is not widely available to clients in Scotland. Online delivery has the potential to expand the reach and accessibility, but special considerations need to be given to designing successful online art therapy services, due to the unique emphasis on the role of an image and artmaking alongside the therapeutic relationship. Methods A pilot online art therapy service was developed and delivered in the Western Isles of Scotland to individual adult clients wishing to increase their psychological wellbeing. This research aimed to assess feasibility and acceptability of the novel service, identify enablers and challenges in setting up and delivering the service, explore participants' expectations and experiences of art therapy and identify any impacts of the service. Mixed-method evaluation incorporated questionnaires, focus groups, interviews and Audio Image Recordings (AIRs). Findings were grouped into themes across several key areas: service setup, research procedures, intervention design and impacts and insights. Recommendations were developed for the first three areas and the last section presents indications of change and gives voice to client experience primarily. Results Online art therapy was described by clients as a judgement-free zone which allowed freedom to experiment, express, feel and immerse themselves in the creative flow. Other benefits included readiness to accept emotions, increased understanding of self and others and being able to see things from a new perspective. Clients recognised the unique nature of art therapy in relation to other psychological treatments and valued the freedom of expression it offered, including the non-verbal. Discussion This project demonstrated that online art therapy is not only a feasible an acceptable intervention, but potentially also a powerfully impactful one, capable of instilling a positive change in a surprisingly short period of time. Exploring ways to expand current and introduce new art therapy services is highly recommended. Refinement of an intervention design, tools and research procedures is recommended through further feasibility studies of a larger scale.
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Affiliation(s)
- Ania Zubala
- Institute of Health Research and Innovation, University of the Highlands and Islands, Inverness, United Kingdom
| | - Nicola Kennell
- Research and Development, Green Tree Arts, Kinbrace, United Kingdom
| | - Catriona MacInnes
- Institute of Health Research and Innovation, University of the Highlands and Islands, Inverness, United Kingdom
| | - Marion MacInnes
- Research and Innovation, NHS Western Isles, Stornoway, United Kingdom
| | - Martin Malcolm
- Research and Innovation, NHS Western Isles, Stornoway, United Kingdom
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