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Perle JG, Chandran DN, Brezler E, Coleman M, Deziel J, Nahhas P, McDonald G, Jent JF. Technology-enhanced practice competencies: scoping review and novel model development. Front Digit Health 2025; 7:1571518. [PMID: 40352328 PMCID: PMC12061994 DOI: 10.3389/fdgth.2025.1571518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Accepted: 04/09/2025] [Indexed: 05/14/2025] Open
Abstract
Introduction With technology routinely integrated into healthcare, it is essential that practitioners obtain skills in the numerous competencies required. Unfortunately, literature to guide use remains inconsistent and fragmented. The current scoping review identified technology-enhanced practice competencies for healthcare practitioners among peer-reviewed literature. Methods A review of PubMed, Scopus, Web of Science, PsycInfo, Global Index Medicus, and Journal of Technology in Behavioral Science was conducted between November 2022 and March 2023. Results 10,583,799 articles were identified, with 109 included in the final review. Seventeen primary competencies were identified with ethics (77.1%), legality (68.8%), and data security (65.1%) among the top three. Conclusions Although multiple technologies across specialties were identified, limited literature comprehensively defined technology-enhanced practice competencies to guide practitioner education. To address this gap, the Intersectional Technology Education and Competency in Healthcare (iTECH) Model was created to clarify educational targets for the use of technology in healthcare practices. Model development and finding applications are discussed.
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Affiliation(s)
- Jonathan G. Perle
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV, United States
| | - Dilip N. Chandran
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV, United States
| | - Emily Brezler
- Department of Internal Medicine and Pediatrics, University of Louisville School of Medicine, Louisville, KY, United States
| | - Michelle Coleman
- West Virginia University School of Medicine, Morgantown, WV, United States
| | - Julia Deziel
- West Virginia University School of Medicine, Morgantown, WV, United States
| | - Patrick Nahhas
- West Virginia University School of Medicine, Morgantown, WV, United States
| | - Gabrielle McDonald
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, United States
| | - Jason F. Jent
- Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
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Starvaggi I, Lorenzo-Luaces L. Psychotherapy Access Barriers and Interest in Digital Mental Health Interventions Among Adults With Treatment Needs: Survey Study. JMIR Ment Health 2025; 12:e65356. [PMID: 40168039 PMCID: PMC12000781 DOI: 10.2196/65356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 12/18/2024] [Accepted: 12/20/2024] [Indexed: 04/02/2025] Open
Abstract
BACKGROUND Digital mental health interventions (DMHIs) are a promising approach to reducing the public health burden of mental illness. DMHIs are efficacious, can provide evidence-based treatment with few resources, and are highly scalable relative to one-on-one face-to-face psychotherapy. There is potential for DMHIs to substantially reduce unmet treatment needs by circumventing structural barriers to treatment access (eg, cost, geography, and time). However, epidemiological research on perceived barriers to mental health care use demonstrates that attitudinal barriers, such as the lack of perceived need for treatment, are the most common self-reported reasons for not accessing care. Thus, the most important barriers to accessing traditional psychotherapy may also be barriers to accessing DMHIs. OBJECTIVE This study aimed to explore whether attitudinal barriers to traditional psychotherapy access might also serve as barriers to DMHI uptake. We explored the relationships between individuals' structural versus attitudinal barriers to accessing psychotherapy and their indicators of potential use of internet-delivered guided self-help (GSH). METHODS We collected survey data from 971 US adults who were recruited online via Prolific and screened for the presence of psychological distress. Participants provided information about demographic characteristics, current symptoms, and the use of psychotherapy in the past year. Those without past-year psychotherapy use (640/971, 65.9%) answered questions about perceived barriers to psychotherapy access, selecting all contributing barriers to not using psychotherapy and a primary barrier. Participants also read detailed information about a GSH intervention. Primary outcomes were participants' self-reported interest in the GSH intervention and self-reported likelihood of using the intervention if offered to them. RESULTS Individuals who had used psychotherapy in the past year reported greater interest in GSH than those who had not (odds ratio [OR] 2.38, 95% CI 1.86-3.06; P<.001) and greater self-reported likelihood of using GSH (OR 2.25, 95% CI 1.71-2.96; P<.001). Attitudinal primary barriers (eg, lack of perceived need; 336/640, 52.5%) were more common than structural primary barriers (eg, money or insurance; 244/640, 38.1%). Relative to endorsing a structural primary barrier, endorsing an attitudinal primary barrier was associated with lower interest in GSH (OR 0.44, 95% CI 0.32-0.6; across all 3 barrier types, P<.001) and lower self-reported likelihood of using GSH (OR 0.61, 95% CI 0.43-0.87; P=.045). We found no statistically significant differences in primary study outcomes by race or ethnicity or by income, but income had a statistically significant relationship with primary barrier type (ORs 0.27-3.71; P=.045). CONCLUSIONS Our findings suggest that attitudinal barriers to traditional psychotherapy use may also serve as barriers to DMHI use, suggesting that disregarding the role of attitudinal barriers may limit the reach of DMHIs. Future research should seek to further understand the relationship between general treatment-seeking attitudes and attitudes about DMHIs to inform the design and marketing of DMHIs.
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Saar CR, Brandes O, Baumel A. Identifying Active Ingredients that Cause Change in Digital Parent Training Programs for Child Behavior Problems: A Qualitative Exploration. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01803-1. [PMID: 39673577 DOI: 10.1007/s10578-024-01803-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2024] [Indexed: 12/16/2024]
Abstract
Digital parent training programs (DPTs) aimed at treating child behavior problems have shown efficacy in a number of trials, but less is known about the active ingredients parents find helpful while using DPTs. We analyzed data from users of self-guided DPTs within a randomized controlled trial setting: a standard program (DPT-STD) and an enhanced program (DPT-TP). Thematic analysis of interviews (n = 16) reveals that users of both programs endorsed the "content", "content presentation", "accessibility", and "therapeutic context" as beneficial. However, only DPT-TP users identified the "therapeutic persuasiveness" as helpful, attributing this to features embedded exclusively in the enhanced program, including call-to-action reminders and assessment-based feedback. Findings were reinforced by the analysis of responses to open-ended questions from a larger sample of users (n = 31 DPT-STD users and n = 34 DPT-TP users). These findings underscore the importance of utilizing features that help parents make positive changes in their home.
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Affiliation(s)
- Chen R Saar
- Department of Community Mental Health, University of Haifa, Abba Khoushy Ave 199, Haifa, 3498838, Israel.
| | - Or Brandes
- Department of Community Mental Health, University of Haifa, Abba Khoushy Ave 199, Haifa, 3498838, Israel
| | - Amit Baumel
- Department of Community Mental Health, University of Haifa, Abba Khoushy Ave 199, Haifa, 3498838, Israel
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Parent J, Jones DJ, DiMarzio K, Yang Y, Wright KL, Sullivan ADW, Forehand R. The Effects of Young Children's Callous-Unemotional Traits on Behaviorally Observed Outcomes in Standard and Technology-Enhanced Behavioral Parent Training. Res Child Adolesc Psychopathol 2023; 51:165-175. [PMID: 36344876 DOI: 10.1007/s10802-022-00979-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/09/2022]
Abstract
Behavioral Parent Training (BPT) remains the current standard of care for early onset behavior disorders (BD); however, problem behaviors characterized by relatively high callous unemotional (CU) traits are linked to poorer treatment outcomes, highlighting the need for novel interventions. This study examined the relation of baseline child CU traits to changes in observed parent and child (3 to 8 years old) behavior in 101 families with low-income randomized to either a standard (Helping the Noncompliant Child, HNC) or technology-enhanced BPT program (TE-HNC). Assessments occurred at baseline, post-intervention, and at a three-month follow-up. Treatment group moderated the relation between CU traits and observed parenting behaviors and child compliance. Specifically, higher levels of child CU traits at baseline predicted lower levels of positive parenting at post-intervention and follow-up, and lower levels of child compliance at follow-up but only in the standard program (HNC). This is the first intervention study to behaviorally assess the differential impact of CU traits in standard, relative to technology-enhanced, BPT and suggests the promise of a technology-enhanced treatment model.
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Affiliation(s)
- Justin Parent
- Department of Psychiatry and Human Behavior, Brown University, Providence, USA.
- Warren Alpert Medical School, Brown University, 1 Hoppin St #204, Providence, RI, USA.
| | - Deborah J Jones
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karissa DiMarzio
- Department of Psychology, Florida International University, Miami, USA
| | - Yexinyu Yang
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kat L Wright
- Department of Psychology, University of Kentucky, Lexington, USA
| | | | - Rex Forehand
- Department of Psychological Science, University of Vermont, Burlington, USA
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Villarreal-Zegarra D, Alarcon-Ruiz CA, Melendez-Torres GJ, Torres-Puente R, Navarro-Flores A, Cavero V, Ambrosio-Melgarejo J, Rojas-Vargas J, Almeida G, Albitres-Flores L, Romero-Cabrera AB, Huarcaya-Victoria J. Development of a Framework for the Implementation of Synchronous Digital Mental Health: Realist Synthesis of Systematic Reviews. JMIR Ment Health 2022; 9:e34760. [PMID: 35348469 PMCID: PMC9006141 DOI: 10.2196/34760] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The use of technologies has served to reduce gaps in access to treatment, and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it is imperative to document the aspects related to their challenging implementation. OBJECTIVE The aim of this study was to determine what evidence is available for synchronous digital mental health implementation and to develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems. METHODS The SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? The MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases were searched from January 1, 2015, to September 2020 with no language restriction. A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) was used to assess the risk of bias and Confidence in Evidence from Reviews of Qualitative Research (CERQual) was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded-theory approach with an emergent approach. RESULTS A total of 21 systematic reviews were included in the study. Among these, 90% (n=19) presented a critically low confidence level as assessed with AMSTAR-2. The realist synthesis allowed for the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: (1) these interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy; (2) these interventions reach populations otherwise unable to have access because they can be successfully delivered by nonspecialists, which makes them more cost-effective to implement in health services; and (3) these interventions are acceptable and show good results in satisfaction because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist. CONCLUSIONS We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represents essential outcomes in the implementation process. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020203811; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203811. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.12688/f1000research.27150.2.
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Affiliation(s)
- David Villarreal-Zegarra
- Escuela de Medicina, Universidad César Vallejo, Trujillo, Peru.,Dirección de Investigación, Desarrollo e Innovación, Instituto Peruano de Orientación Psicológica, Lima, Peru
| | - Christoper A Alarcon-Ruiz
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter, Devon, United Kingdom
| | - Roberto Torres-Puente
- Dirección de Investigación, Desarrollo e Innovación, Instituto Peruano de Orientación Psicológica, Lima, Peru
| | - Alba Navarro-Flores
- Dirección de Investigación, Desarrollo e Innovación, Instituto Peruano de Orientación Psicológica, Lima, Peru.,Georg-August-University Göttingen, International Max Planck Research School for Neurosciences, Göttingen, Germany
| | - Victoria Cavero
- Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Ambrosio-Melgarejo
- Dirección de Investigación, Desarrollo e Innovación, Instituto Peruano de Orientación Psicológica, Lima, Peru
| | | | - Guillermo Almeida
- Dirección de Investigación, Desarrollo e Innovación, Instituto Peruano de Orientación Psicológica, Lima, Peru
| | - Leonardo Albitres-Flores
- Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Peru
| | - Alejandra B Romero-Cabrera
- Carrera Profesional de Medicina Humana, Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru
| | - Jeff Huarcaya-Victoria
- Unidad de Psiquiatría de Enlace, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.,Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Filial Ica, Peru
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Baweja R, Soutullo CA, Waxmonsky JG. Review of barriers and interventions to promote treatment engagement for pediatric attention deficit hyperactivity disorder care. World J Psychiatry 2021; 11:1206-1227. [PMID: 35070771 PMCID: PMC8717033 DOI: 10.5498/wjp.v11.i12.1206] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/20/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common and impairing behavioral health disorder, impacting over 5% of children worldwide. There are multiple evidence-based pharmacological and psychosocial treatments for ADHD, and greater service utilization is associated with improved acute and long-term outcomes. However, long-term outcomes are suboptimal as multimodal treatments are often not accessed and most care ends prematurely. This narrative review discusses barriers to engagement for children and adolescents with ADHD and their families as well as interventions to overcome these barriers. Families face a variety of structural and attitudinal barriers, ranging from cost and access to stigma and low self-efficacy to successfully implement change. There are multiple interventions that may enhance engagement with ADHD care including psychoeducation, integration of behavioral services in general medical settings, telehealth as well as specific adaptations to existing ADHD treatments, such as the use of motivational interviewing or shared decision making. Integration of behavioral health into general medical settings and telehealth have been found in controlled studies to increase access by reducing both structural and attitudinal barriers. Adding motivational interviewing, shared decision making and other engagement interventions to evidence-based ADHD treatments has been found to reduce attitudinal barriers that translates into improved participation and satisfaction while enhancing outcomes. However, little is known about how to promote extended engagement with ADHD services even though a chronic care model for ADHD is recommended.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
| | - Cesar A Soutullo
- Louis A. Faillace, MD Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77054, United States
| | - James G Waxmonsky
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
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Barnett ML, Sigal M, Green Rosas Y, Corcoran F, Rastogi M, Jent JF. Therapist Experiences and Attitudes About Implementing Internet-Delivered Parent-Child Interaction Therapy During COVID-19. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:630-641. [PMID: 33994769 PMCID: PMC8112899 DOI: 10.1016/j.cbpra.2021.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 03/19/2021] [Indexed: 12/01/2022]
Abstract
It has been widely recognized that access to mental health treatment is imperative to address current and long-term stressors for children and parents during COVID-19. Internet-delivered Parent-Child Interaction Therapy (iPCIT, previously referred to as I-PCIT) is a strong model for remote service delivery during social distancing restrictions due to its empirical base. However, this treatment modality was not widely implemented before COVID-19, likely due to barriers to providing telehealth services. This mixed methods study conducted a follow-up survey to gather therapist experiences (N = 223) in delivering iPCIT during COVID-19, including qualitative data on the benefits and challenges to delivering iPCIT. The vast majority of therapists (82%) indicated that they transitioned to deliver PCIT via telehealth in response to COVID-19. PCIT caseloads decreased slightly from the first survey to the COVID-19 follow-up survey, but the racial and ethnic composition of caseloads were not significantly different between the two surveys. Of the 183 therapists who transitioned to deliver PCIT via telehealth, 82% expressed interest in continuing to provide iPCIT following the COVID-19 pandemic. Reported benefits of iPCIT included decreased barriers to access and the ability to practice skills within the naturalistic home environment. Challenges to iPCIT were primarily issues with technology as well as other logistical barriers, which could limit engagement for some families. Findings from this study may be beneficial in improving future implementation of iPCIT during and post-COVID-19.
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Baek Y, Jeong K, Lee S, Kim H, Seo BN, Jin HJ. Feasibility and Effectiveness of Assessing Subhealth Using a Mobile Health Management App (MibyeongBogam) in Early Middle-Aged Koreans: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e27455. [PMID: 34420922 PMCID: PMC8414299 DOI: 10.2196/27455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/11/2021] [Accepted: 07/09/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) is a major source of health management systems. Moreover, the demand for mHealth, which is in need of change due to the COVID-19 pandemic, is increasing worldwide. Accordingly, interest in health care in everyday life and the importance of mHealth are growing. OBJECTIVE We developed the MibyeongBogam (MBBG) app that evaluates the user's subhealth status via a smartphone and provides a health management method based on that user's subhealth status for use in everyday life. Subhealth is defined as a state in which the capacity to recover to a healthy state is diminished, but without the presence of clinical disease. The objective of this study was to compare the awareness and status of subhealth after the use of the MBBG app between intervention and control groups, and to evaluate the app's practicality. METHODS This study was a prospective, open-label, parallel group, randomized controlled trial. The study was conducted at two hospitals in Korea with 150 healthy people in their 30s and 40s, at a 1:1 allocation ratio. Participants visited the hospital three times as follows: preintervention, intermediate visit 6 weeks after the intervention, and final visit 12 weeks after the intervention. Key endpoints were measured at the first visit before the intervention and at 12 weeks after the intervention. The primary outcome was the awareness of subhealth, and the secondary outcomes were subhealth status, health-promoting behaviors, and motivation to engage in healthy behaviors. RESULTS The primary outcome, subhealth awareness, tended to slightly increase for both groups after the uncompensated intervention, but there was no significant difference in the score between the two groups (intervention group: mean 23.69, SD 0.25 vs control group: mean 23.1, SD 0.25; P=.09). In the case of secondary outcomes, only some variables of the subhealth status showed significant differences between the two groups after the intervention, and the intervention group showed an improvement in the total scores of subhealth (P=.03), sleep disturbance (P=.02), depression (P=.003), anger (P=.01), and anxiety symptoms (P=.009) compared with the control group. CONCLUSIONS In this study, the MBBG app showed potential for improving the health, especially with regard to sleep disturbance and depression, of individuals without particular health problems. However, the effects of the app on subhealth awareness and health-promoting behaviors were not clearly evaluated. Therefore, further studies to assess improvements in health after the use of personalized health management programs provided by the MBBG app are needed. The MBBG app may be useful for members of the general public, who are not diagnosed with a disease but are unable to lead an optimal daily life due to discomfort, to seek strategies that can improve their health. TRIAL REGISTRATION Clinical Research Information Service KCT0003488; https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=14379.
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Affiliation(s)
- Younghwa Baek
- Korean Medicine Data Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Kyoungsik Jeong
- Korean Medicine Data Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Siwoo Lee
- Korean Medicine Data Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Hoseok Kim
- Korean Medicine Data Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Bok-Nam Seo
- Korean Medicine Data Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Hee-Jeong Jin
- Korean Medicine Data Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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Rimer E, Husby LV, Solem S. Virtual Reality Exposure Therapy for Fear of Heights: Clinicians' Attitudes Become More Positive After Trying VRET. Front Psychol 2021; 12:671871. [PMID: 34335386 PMCID: PMC8319686 DOI: 10.3389/fpsyg.2021.671871] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background Virtual reality exposure therapy (VRET) has the potential to solve logistic challenges when treating specific phobias. However, VRET has yet to see a large-scale implementation in clinical settings despite positive findings in treatment trials. This may partly be due to attitudes and lack of experience among clinicians, but also because of expensive and stationary VR solutions. Objective This study tested whether modern, wireless, commercially available VR equipment with controller-free hand tracking could induce and reduce discomfort using scenarios designed for fear of heights. Also, the study tested if clinicians’ attitudes toward using VR in therapy changed after trying it themselves. Method Attitudes to using VR in therapy and discomfort ratings were assessed for 74 clinicians before and after completing two VR scenarios. In addition, 54 non-clinicians completed the same scenarios. Participants were not diagnosed with acrophobia. Results The VR scenarios induced discomfort comparable to participants’ reported fear of heights in real life. Repeated training reduced discomfort. Positive attitudes toward use of VR in therapy was predicted by previous experience with VR, as well as positive attitudes toward novel technology and exposure therapy. Clinicians’ attitudes became more favorable after trying VRET themselves. Clinicians reported a range of possible advantages and disadvantages of using VR in therapy. Conclusion VRET for fear of heights was able to induce and reduce discomfort in clinicians and non-clinicians, and clinicians’ attitudes toward using VRET become more positive after trying VRET for themselves. The latest generation of VR solutions has potential to improve clinical availability and treatment options. Future research should explore how VRET can be implemented in clinical settings.
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Affiliation(s)
- Elise Rimer
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Vågsholm Husby
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Matanov A, McNamee P, Akther S, Barber N, Bird V. Acceptability of a technology-supported and solution-focused intervention (DIALOG+) for chronic depression: views of service users and clinicians. BMC Psychiatry 2021; 21:263. [PMID: 34016079 PMCID: PMC8139109 DOI: 10.1186/s12888-021-03256-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 05/03/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Treating chronic depression represents a significant burden for the NHS, yet there is a lack of evidence-based interventions and research specifically focused on this condition. DIALOG+, a technology-assisted and resource-oriented intervention found effective for people with psychosis, may improve care for this service user group. The aim of this study was to explore the acceptability and relevance of DIALOG+ for the treatment of chronic depression in community-based settings. METHODS A convenience sample of 16 mental health professionals and 29 service users with chronic depression tested the DIALOG+ intervention in routine community care appointments for 3 months across 3 different mental health NHS Trusts in England. Of these, 15 clinicians and 19 service users were individually interviewed about their experiences. Interview transcripts were analysed using thematic analysis by an analytic team which included a service user researcher. RESULTS Analysis of the combined dataset identified five overarching themes: DIALOG+ Structure; Therapeutic Communication; Reflecting and Monitoring; Empowerment and Powerlessness; and The Impact of Technology. Overall, service users and clinicians were interested in the continued use of DIALOG+ as part of routine care. CONCLUSIONS DIALOG+ was viewed as acceptable by both service users with chronic depression and their clinicians who work in community care settings, albeit with some caveats. Clinician training required significant improvements to address the issues that were referenced, most notably around support with using technology.
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Affiliation(s)
- Aleksandra Matanov
- The Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, NCfMH, London, E13 8SP, UK.
| | - Philip McNamee
- grid.450709.f0000 0004 0426 7183East London NHS Foundation Trust, NCfMH, London, E13 8SP UK
| | - Syeda Akther
- grid.4868.20000 0001 2171 1133The Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, NCfMH, London, E13 8SP UK
| | - Nick Barber
- grid.450709.f0000 0004 0426 7183East London NHS Foundation Trust, NCfMH, London, E13 8SP UK
| | - Victoria Bird
- grid.4868.20000 0001 2171 1133The Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, NCfMH, London, E13 8SP UK
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A review of implementation frameworks to operationalize health technology assessment recommendations for medical technologies in the Singapore setting. Int J Technol Assess Health Care 2021; 37:e56. [PMID: 33843519 DOI: 10.1017/s0266462321000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Methodologies of health technology assessment (HTA) for medical technologies are well established; yet, operational frameworks that enable appropriate uptake of HTA recommendations into routine clinical practice are lacking. This review aims to identify the key themes needed to guide the planning and implementation of HTA subsidy decisions for medical technologies such as diagnostics, medical devices, and services and to monitor their impact on a complex multipayer healthcare system like Singapore. METHODS A literature search of implementation frameworks was conducted up to 20 December 2020 and was documented in a flow diagram. A thematic analysis of the evidence base was performed using the Braun and Clark approach to identify key themes, from which an implementation framework suitable for Singapore's healthcare system could be developed. RESULTS The searches yielded forty-four articles for review, from which twenty themes were identified. The top ten themes constituted the key themes of implementation essential for local adaptation and were categorized into five domains: implementation strategy, organizational support, stakeholder engagement, information dissemination, and implementation outcomes and evaluation. These domains provide operational guidance to methodically identify gaps to facilitate sustainable implementation of HTA-informed medical technology subsidy decisions. CONCLUSION A robust and adaptable implementation of HTA-informed subsidy decisions is crucial to optimize its intended impact of improving patient outcomes per dollar spent. The key themes of an implementation framework should capture the important aspects of organizational feasibility to ensure successful adoption in a complex multipayer healthcare system like Singapore.
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Jones DJ, Loiselle R, Zachary C, Georgeson AR, Highlander A, Turner P, Youngstrom JK, Khavjou O, Anton MT, Gonzalez M, Bresland NL, Forehand R. Optimizing Engagement in Behavioral Parent Training: Progress Toward a Technology-Enhanced Treatment Model. Behav Ther 2021; 52:508-521. [PMID: 33622517 PMCID: PMC7362816 DOI: 10.1016/j.beth.2020.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/26/2022]
Abstract
Low-income families are more likely to have a child with an early-onset Behavior Disorder (BD); yet, socioeconomic strain challenges engagement in Behavioral Parent Training (BPT). This study follows a promising pilot to further examine the potential to cost-effectively improve low-income families' engagement in and the efficiency of BPT. Low-income families were randomized to (a) Helping the Noncompliant Child (HNC; McMahon & Forehand, 2003), a weekly, mastery-based BPT program that includes both the parent and child or (b) Technology-Enhanced HNC (TE-HNC), which includes all of the standard HNC components plus a parent mobile application and therapist web portal that provide between-session monitoring, modeling, and coaching of parent skill use with the goal of improved engagement in the context of financial strain. Relative to HNC, TE-HNC families had greater homework compliance and mid-week call participation. TE-HNC completers also required fewer weeks to achieve skill mastery and, in turn, to complete treatment than those in HNC without compromising parent satisfaction with treatment; yet, session attendance and completion were not different between groups. Future directions and clinical implications are discussed.
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13
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Kawadler JM, Hemmings NR, Ponzo S, Morelli D, Bird G, Plans D. Effectiveness of a Smartphone App (BioBase) for Reducing Anxiety and Increasing Mental Well-Being: Pilot Feasibility and Acceptability Study. JMIR Form Res 2020; 4:e18067. [PMID: 32969341 PMCID: PMC7685925 DOI: 10.2196/18067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/18/2020] [Accepted: 09/15/2020] [Indexed: 01/26/2023] Open
Abstract
Background The prevalence of workplace-related stress and anxiety is high, resulting in stress-related physical and mental illness. Digital self-guided interventions aimed at key areas of workplace design may be able to provide remote anxiolytic effects. Objective The aim of this feasibility study is to assess changes in anxiety and mental well-being after use of the BioBase programme, a mobile phone platform for psycho-educational modules, tools, and real-time feedback of physiological data. Methods A 4-week observational study was carried out in 55 healthy adults who were screened for stress with the Depression Anxiety Stress Scale (DASS) Stress subscale. Participants completed anxiety (6-item State-Trait Anxiety Inventory [STAI]) and mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) questionnaires at baseline and at 4 weeks. Feedback questionnaires were administered after 4 weeks. Results After 4 weeks of using the programme and controlling for any effect of being paid to take part in the study, STAI significantly decreased (baseline mean 45.52 [SD 13.2]; 4-week mean 39.82 [SD 11.2]; t54=–3.51; P<.001; CI –8.88 to –2.52; Cohen d=0.96) and WEMWBS significantly increased (baseline mean 48.12 [SD 6.4]; 4-week mean 50.4 [SD 6.9]; t53=2.41; P=.019; CI 0.44-4.23; Cohen d=0.66). Further, higher baseline stress was significantly associated with a greater decrease in STAI (t53=–3.41; P=.001; CI –8.10 to –2.10; R2=0.180) and a greater increase in WEMWBS (t52=2.41; P=.019; CI 0.38-4.11, R2=0.101). On feedback, participants found the programme easy to use/navigate, with the content being acceptable and relevant to workplace-related stressors; 70% (21/30) of participants would recommend the programme to a friend. Conclusions The BioBase programme is a potentially effective intervention in decreasing anxiety and increasing mental well-being, with larger changes in those with higher baseline levels of stress.
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Affiliation(s)
- Jamie M Kawadler
- Huma Therapeutics Limited, 13th Floor Millbank Tower, 21-24 Millbank, London, United Kingdom
| | - Nicola Rose Hemmings
- Huma Therapeutics Limited, 13th Floor Millbank Tower, 21-24 Millbank, London, United Kingdom
| | - Sonia Ponzo
- Huma Therapeutics Limited, 13th Floor Millbank Tower, 21-24 Millbank, London, United Kingdom
| | - Davide Morelli
- Huma Therapeutics Limited, 13th Floor Millbank Tower, 21-24 Millbank, London, United Kingdom.,Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - David Plans
- Huma Therapeutics Limited, 13th Floor Millbank Tower, 21-24 Millbank, London, United Kingdom.,Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.,Department of SITE, University of Exeter, Exeter, United Kingdom
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14
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Graham AK, Lattie EG, Powell BJ, Lyon AR, Smith JD, Schueller SM, Stadnick NA, Brown CH, Mohr DC. Implementation strategies for digital mental health interventions in health care settings. ACTA ACUST UNITED AC 2020; 75:1080-1092. [PMID: 33252946 DOI: 10.1037/amp0000686] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
U.S. health care systems are tasked with alleviating the burden of mental health, but are frequently underprepared and lack workforce and resource capacity to deliver services to all in need. Digital mental health interventions (DMHIs) can increase access to evidence-based mental health care. However, DMHIs commonly do not fit into the day-to-day activities of the people who engage with them, resulting in a research-to-practice gap for DMHI implementation. For health care settings, differences between digital and traditional mental health services make alignment and integration challenging. Specialized attention is needed to improve the implementation of DMHIs in health care settings so that these services yield high uptake, engagement, and sustainment. The purpose of this article is to enhance efforts to integrate DMHIs in health care settings by proposing implementation strategies, selected and operationalized based on the discrete strategies established in the Expert Recommendations for Implementing Change project, that align to DMHI-specific barriers in these settings. Guidance is offered in how these strategies can be applied to DMHI implementation across four phases commonly distinguished in implementation science using the Exploration, Preparation, Implementation, Sustainment Framework. Next steps to advance research in this area and improve the research-to-practice gap for implementing DMHIs are recommended. Applying implementation strategies to DMHI implementation will enable psychologists to systematically evaluate this process, which can yield an enhanced understanding of the factors that facilitate implementation success and improve the translation of DMHIs from controlled trials to real-world settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Northwestern University
| | | | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Justin D Smith
- Center for Prevention Implementation Methodology, Northwestern University
| | | | | | - C Hendricks Brown
- Center for Prevention Implementation Methodology, Northwestern University
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University
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15
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Greenhalgh T, Maylor H, Shaw S, Wherton J, Papoutsi C, Betton V, Nelissen N, Gremyr A, Rushforth A, Koshkouei M, Taylor J. The NASSS-CAT Tools for Understanding, Guiding, Monitoring, and Researching Technology Implementation Projects in Health and Social Care: Protocol for an Evaluation Study in Real-World Settings. JMIR Res Protoc 2020; 9:e16861. [PMID: 32401224 PMCID: PMC7254278 DOI: 10.2196/16861] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/06/2019] [Accepted: 12/13/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Projects to implement health care and social care innovations involving technologies are typically ambitious and complex. Many projects fail. Greenhalgh et al's nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to analyze the varied outcomes of such projects. OBJECTIVE We sought to extend the NASSS framework to produce practical tools for understanding, guiding, monitoring, and researching technology projects in health care or social care settings. METHODS Building on NASSS and a complexity assessment tool (CAT), the NASSS-CAT tools were developed (in various formats) in seven co-design workshops involving 50 stakeholders (industry executives, technical designers, policymakers, managers, clinicians, and patients). Using action research, they were and are being tested prospectively on a sample of case studies selected for variety in conditions, technologies, settings, scope and scale, policy context, and project goals. RESULTS The co-design process resulted in four tools, available as free downloads. NASSS-CAT SHORT is a taster to introduce the instrument and gauge interest. NASSS-CAT LONG is intended to support reflection, due diligence, and preliminary planning. It maps complexity through stakeholder discussion across six domains, using free-text open questions (designed to generate a rich narrative and surface uncertainties and interdependencies) and a closed-question checklist; this version includes an action planning section. NASSS-CAT PROJECT is a 35-item instrument for monitoring how subjective complexity in a technology implementation project changes over time. NASSS-CAT INTERVIEW is a set of prompts for conducting semistructured research or evaluation interviews. Preliminary data from empirical case studies suggest that the NASSS-CAT tools can potentially identify, but cannot always help reconcile, contradictions and conflicts that block projects' progress. CONCLUSIONS The NASSS-CAT tools are a useful addition to existing implementation tools and frameworks. Further support of the implementation projects is ongoing. We are currently producing digital versions of the tools, and plan (subject to further funding) to establish an online community of practice for people interested in using and improving the tools, and hold workshops for building cross-project collaborations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16861.
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Affiliation(s)
- Trisha Greenhalgh
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Harvey Maylor
- Said Business School, University of Oxford, Oxford, United Kingdom
| | - Sara Shaw
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Chrysanthi Papoutsi
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | | | - Andreas Gremyr
- Department of Schizophrenia Spectrum Disorders (Psykiatri Psykos), Sahlgrenska University Hospital, Mölndal, Sweden
| | - Alexander Rushforth
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mona Koshkouei
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - John Taylor
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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16
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Georgeson AR, Highlander A, Loiselle R, Zachary C, Jones DJ. Engagement in technology-enhanced interventions for children and adolescents: Current status and recommendations for moving forward. Clin Psychol Rev 2020; 78:101858. [PMID: 32413679 DOI: 10.1016/j.cpr.2020.101858] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/25/2020] [Accepted: 04/22/2020] [Indexed: 01/09/2023]
Abstract
Treatment engagement is a primary challenge to the effectiveness of evidence-based treatments for children and adolescents. One solution to this challenge is technology, which has been proposed as an enhancement to or replacement for standard clinic-based, therapist delivered services. This review summarizes the current state of the field regarding technology's promise to enhance engagement. A review of this literature suggests that although the focus of much theoretical consideration, as well as funding priorities, relatively little empirical research has been published on the role of technology as a vehicle to enhance engagement in particular. Moreover, lack of consistency in constructs, design, and measures make it difficult to draw useful comparisons across studies and, in turn, to determine if and what progress has been made toward more definitive conclusions. At this point in the literature, we can say only that we do not yet definitively know if technology does (or does not) enhance engagement in evidence-based treatments for children and adolescents. Recommendations are provided with the hope of more definitively assessing technology's capacity to improve engagement, including more studies explicitly designed to assess this research question, as well as greater consistency across studies in the measurement of and designs used to test engagement.
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Affiliation(s)
- A R Georgeson
- Department of Psychology & Neuroscience, The University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC 27599-3270, USA.
| | - April Highlander
- Department of Psychology & Neuroscience, The University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC 27599-3270, USA
| | - Raelyn Loiselle
- Department of Psychology & Neuroscience, The University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC 27599-3270, USA
| | - Chloe Zachary
- Department of Psychology & Neuroscience, The University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC 27599-3270, USA
| | - Deborah J Jones
- Department of Psychology & Neuroscience, The University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC 27599-3270, USA.
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Hunkin H, King DL, Zajac IT. Perceived acceptability of wearable devices for the treatment of mental health problems. J Clin Psychol 2020; 76:987-1003. [PMID: 32022908 DOI: 10.1002/jclp.22934] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study examined the potential acceptability of wearable devices (e.g., smart headbands, wristbands, and watches) aimed at treating mental health disorders, relative to conventional approaches. METHODS A questionnaire assessed perceptions of wearable and nonwearable treatments, along with demographic and psychological information. Respondents (N = 427) were adults from a community sample (Mage = 44.6, SDage = 15.3) which included current (30.2%) and former (53.9%) mental health help-seekers. RESULTS Perceived effectiveness of wearables was a strong predictor of interest in using them as adjuncts to talk therapies, or as an alternative to self-help options (e.g., smartphone applications). Devices were more appealing to those with negative evaluations of psychological therapy and less experience in help-seeking. CONCLUSIONS Interest in using wearable devices was strong, particularly when devices were seen as effective. Clients with negative attitudes to conventional therapies may be more responsive to using wearable devices as a less directive treatment approach.
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Affiliation(s)
- Hugh Hunkin
- Nutrition and Health Research Program, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Australia.,School of Psychology, University of Adelaide, Adelaide, Australia
| | - Daniel L King
- School of Psychology, University of Adelaide, Adelaide, Australia.,College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Ian T Zajac
- Nutrition and Health Research Program, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Australia.,School of Psychology, University of Adelaide, Adelaide, Australia
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18
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Abimbola S, Patel B, Peiris D, Patel A, Harris M, Usherwood T, Greenhalgh T. The NASSS framework for ex post theorisation of technology-supported change in healthcare: worked example of the TORPEDO programme. BMC Med 2019; 17:233. [PMID: 31888718 PMCID: PMC6937726 DOI: 10.1186/s12916-019-1463-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluation of health technology programmes should be theoretically informed, interdisciplinary, and generate in-depth explanations. The NASSS (non-adoption, abandonment, scale-up, spread, sustainability) framework was developed to study unfolding technology programmes in real time-and in particular to identify and manage their emergent uncertainties and interdependencies. In this paper, we offer a worked example of how NASSS can also inform ex post (i.e. retrospective) evaluation. METHODS We studied the TORPEDO (Treatment of Cardiovascular Risk in Primary Care using Electronic Decision Support) research programme, a multi-faceted computerised quality improvement intervention for cardiovascular disease prevention in Australian general practice. The technology (HealthTracker) had shown promise in a cluster randomised controlled trial (RCT), but its uptake and sustainability in a real-world implementation phase was patchy. To explain this variation, we used NASSS to undertake secondary analysis of the multi-modal TORPEDO dataset (results and process evaluation of the RCT, survey responses, in-depth professional interviews, videotaped consultations) as well as a sample of new, in-depth narrative interviews with TORPEDO researchers. RESULTS Ex post analysis revealed multiple areas of complexity whose influence and interdependencies helped explain the wide variation in uptake and sustained use of the HealthTracker technology: the nature of cardiovascular risk in different populations, the material properties and functionality of the technology, how value (financial and non-financial) was distributed across stakeholders in the system, clinicians' experiences and concerns, organisational preconditions and challenges, extra-organisational influences (e.g. policy incentives), and how interactions between all these influences unfolded over time. CONCLUSION The NASSS framework can be applied retrospectively to generate a rich, contextualised narrative of technology-supported change efforts and the numerous interacting influences that help explain its successes, failures, and unexpected events. A NASSS-informed ex post analysis can supplement earlier, contemporaneous evaluations to uncover factors that were not apparent or predictable at the time but dynamic and emergent.
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Affiliation(s)
- Seye Abimbola
- School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
- Centre for Health Systems Science, The George Institute for Global Health, University of New South Wales, Level 5/1 King St, Newtown, NSW, 2042, Australia
| | - Bindu Patel
- Centre for Health Systems Science, The George Institute for Global Health, University of New South Wales, Level 5/1 King St, Newtown, NSW, 2042, Australia
| | - David Peiris
- Centre for Health Systems Science, The George Institute for Global Health, University of New South Wales, Level 5/1 King St, Newtown, NSW, 2042, Australia
| | - Anushka Patel
- Centre for Health Systems Science, The George Institute for Global Health, University of New South Wales, Level 5/1 King St, Newtown, NSW, 2042, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Tim Usherwood
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Trisha Greenhalgh
- Centre for Health Systems Science, The George Institute for Global Health, University of New South Wales, Level 5/1 King St, Newtown, NSW, 2042, Australia.
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
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19
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Conducting Psychological Intervention Research in the Information Age: Reconsidering the "State of the Field". ACTA ACUST UNITED AC 2019; 4:210-218. [PMID: 31737779 DOI: 10.1007/s41347-018-0072-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Enthusiasm for technology in mental health has evolved as a function of its promise to increase the reach and impact of services, particularly for traditionally at-risk and underserved groups. Preliminary findings suggest that technology-enhanced interventions indeed hold promise for increasing engagement in and outcomes of evidence-based treatment approaches. The time- and resourceintensive nature of traditional randomized control trials, however, may be even more of a challenge for further advancement in this area, given the rapid innovation of consumer driven new product development. Accordingly, this review aims to summarize how a broader range of scientific designs and analyses may be necessary in order to further advance and optimize the reach and impact of technology-enhanced psychological practice. Examples of various approaches are provided and recommendations are provided for future work in this area.
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20
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Chiauzzi E, Newell A. Mental Health Apps in Psychiatric Treatment: A Patient Perspective on Real World Technology Usage. JMIR Ment Health 2019; 6:e12292. [PMID: 31008711 PMCID: PMC6658296 DOI: 10.2196/12292] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/29/2019] [Accepted: 03/12/2019] [Indexed: 01/06/2023] Open
Abstract
For many people who use mobile apps, the primary motivations are entertainment, news, gaming, social connections, or productivity. For those experiencing health problems, particularly those with chronic conditions such as psychiatric disorders, the stakes are much higher. The digital tools that they select may be the difference between improvement and decompensation or even life and death. Although there has been a wide expansion of mental health apps with promise as well as hype, the current means of researching, evaluating, and deploying effective tools have been problematic. As a means of gaining a perspective that moves beyond usability testing, surveys, and app ratings, the primary objective of this patient perspective is to question the killer app and condition-specific mentality of current mental health app development. We do this by reviewing the current mobile mental health app literature, identifying ways in which psychiatric patients use apps in their lives, and then exploring how these issues are experienced by a software engineer who has struggled with her bipolar disorder for many years. Her lived experience combined with a technology perspective offers potential avenues for using technology productively in psychiatric treatment. We believe that this responds to JMIR Publications' call for patient perspective papers and provides encouragement for patients to share their views on mental health and technology.
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Abstract
This commentary highlights the importance and promise of the innovative strategies described in the Child Maltreatment special issue on "Technology 2.0: A Focus on the Newest Technological Advances in Child Maltreatment Research." The commentary first highlights the collective advancements reflected in the articles in the special issue, with a primary focus on how the authors' work addresses a general challenge in services research that is perhaps nowhere more problematic than in the field of maltreatment. Next, the commentary extends the discussion of these articles to raise remaining gaps in our knowledge, theory, and methodology, which must be the focus of ongoing research if the true potential of technology as a service delivery vehicle is to be realized. Finally, the commentary concludes with a call for subsequent research which will be inspired by the articles in this special issue.
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Affiliation(s)
- Deborah J Jones
- 1 Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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22
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Greenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, A'Court C, Hinder S, Fahy N, Procter R, Shaw S. Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies. J Med Internet Res 2017; 19:e367. [PMID: 29092808 PMCID: PMC5688245 DOI: 10.2196/jmir.8775] [Citation(s) in RCA: 1055] [Impact Index Per Article: 131.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/08/2017] [Accepted: 09/23/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at the organization or system level. OBJECTIVE Our objective was to produce an evidence-based, theory-informed, and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program. METHODS The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) to identify key domains, and (2) empirical case studies of technology implementation to explore, test, and refine these domains. We studied 6 technology-supported programs-video outpatient consultations, global positioning system tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organizing software, and integrated case management via data sharing-using longitudinal ethnography and action research for up to 3 years across more than 20 organizations. Data were collected at micro level (individual technology users), meso level (organizational processes and systems), and macro level (national policy and wider context). Analysis and synthesis was aided by sociotechnically informed theories of individual, organizational, and system change. The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback. RESULTS The literature review identified 28 previous technology implementation frameworks, of which 14 had taken a dynamic systems approach (including 2 integrative reviews of previous work). Our empirical dataset consisted of over 400 hours of ethnographic observation, 165 semistructured interviews, and 200 documents. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework included questions in 7 domains: the condition or illness, the technology, the value proposition, the adopter system (comprising professional staff, patient, and lay caregivers), the organization(s), the wider (institutional and societal) context, and the interaction and mutual adaptation between all these domains over time. Our empirical case studies raised a variety of challenges across all 7 domains, each classified as simple (straightforward, predictable, few components), complicated (multiple interacting components or issues), or complex (dynamic, unpredictable, not easily disaggregated into constituent components). Programs characterized by complicatedness proved difficult but not impossible to implement. Those characterized by complexity in multiple NASSS domains rarely, if ever, became mainstreamed. The framework showed promise when applied (both prospectively and retrospectively) to other programs. CONCLUSIONS Subject to further empirical testing, NASSS could be applied across a range of technological innovations in health and social care. It has several potential uses: (1) to inform the design of a new technology; (2) to identify technological solutions that (perhaps despite policy or industry enthusiasm) have a limited chance of achieving large-scale, sustained adoption; (3) to plan the implementation, scale-up, or rollout of a technology program; and (4) to explain and learn from program failures.
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Affiliation(s)
- Trisha Greenhalgh
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Chrysanthi Papoutsi
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jennifer Lynch
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Gemma Hughes
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Christine A'Court
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Susan Hinder
- RAFT Research and Consulting Ltd, Clitheroe, Lancs, United Kingdom
| | - Nick Fahy
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rob Procter
- Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Sara Shaw
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Chou T, Bry LJ, Comer JS. Overcoming traditional barriers only to encounter new ones: Doses of caution and direction as technology‐enhanced treatments begin to “go live”. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2017. [DOI: 10.1111/cpsp.12196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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