Operationalizing Engagement With an Interpretation Bias Smartphone App Intervention: Case Series.
Ontology highlight
ABSTRACT: Background
Engagement with mental health smartphone apps is an understudied but critical construct to understand in the pursuit of improved efficacy.Objective
This study aimed to examine engagement as a multidimensional construct for a novel app called HabitWorks. HabitWorks delivers a personalized interpretation bias intervention and includes various strategies to enhance engagement such as human support, personalization, and self-monitoring.Methods
We examined app use in a pilot study (n=31) and identified 5 patterns of behavioral engagement: consistently low, drop-off, adherent, high diary, and superuser.Results
We present a series of cases (5/31, 16%) from this trial to illustrate the patterns of behavioral engagement and cognitive and affective engagement for each case. With rich participant-level data, we emphasize the diverse engagement patterns and the necessity of studying engagement as a heterogeneous and multifaceted construct.Conclusions
Our thorough idiographic exploration of engagement with HabitWorks provides an example of how to operationalize engagement for other mental health apps.
SUBMITTER: Ramadurai R
PROVIDER: S-EPMC9434389 | biostudies-literature | 2022 Aug
REPOSITORIES: biostudies-literature
Publications
Operationalizing Engagement With an Interpretation Bias Smartphone App Intervention: Case Series.
Ramadurai Ramya R Beckham Erin E McHugh R Kathryn RK Björgvinsson Thröstur T Beard Courtney C
JMIR mental health 20220817 8
<h4>Background</h4>Engagement with mental health smartphone apps is an understudied but critical construct to understand in the pursuit of improved efficacy.<h4>Objective</h4>This study aimed to examine engagement as a multidimensional construct for a novel app called HabitWorks. HabitWorks delivers a personalized interpretation bias intervention and includes various strategies to enhance engagement such as human support, personalization, and self-monitoring.<h4>Methods</h4>We examined app use i ...[more]
Similar Datasets
Project description:BackgroundAccess to evidence-based interventions is urgently required, especially for individuals of minoritized identities who experience unique barriers to mental health care. Digital mental health interventions have the potential to increase accessibility. Previous pilot studies testing HabitWorks, a smartphone app providing an interpretation bias intervention, have found strong engagement and adherence for HabitWorks; however, previous trials' samples consisted of predominantly non-Hispanic, White individuals.ObjectiveThis study conducted an open trial of HabitWorks in a community sample of adults who identified as Black, Hispanic or Latinx, or both. This study aims to test safety, acceptability, and engagement with the HabitWorks app for Black and Latinx adults.MethodsBlack, Hispanic or Latinx adults (mean age 32.83, SD 11.06 y; 22/31, 71% women) who endorsed symptoms of anxiety or depression were asked to complete interpretation modification exercises via HabitWorks 3 times per week for 1 month. Interpretation bias and anxiety and depression symptoms were assessed at baseline and posttreatment assessments. Participants completed qualitative interviews to assess overall perceptions of HabitWorks.ResultsOf the 31 participants that downloaded the app, 27 (87%) used HabitWorks all 4 weeks. On average, participants completed 15.74 (SD 7.43) exercises out of the 12 prescribed, demonstrating high engagement. Acceptability ratings met all a priori benchmarks except for relevancy. Qualitative interviews also demonstrated high acceptability and few negative experiences. Significant improvements were found in interpretation style (t30=2.29; P<.001), with a large effect size (Cohen d=1.53); anxiety symptoms (t30=2.29; P=.03), with a small effect size (Cohen d=0.41); and depression symptoms (t30=3.065; P=.005), with a medium effect size (Cohen d=0.55).ConclusionsThis study adds to the literature evaluating digital mental health interventions in Black and Latinx adults. Preliminary results further support a future controlled trial testing the effectiveness of HabitWorks as an intervention.
| S-EPMC11325113 | biostudies-literature
Project description:There is a need for clear strategies and procedures to operationalize stakeholder engagement in research studies. Clear guidelines that promote shared leadership among study investigators and research stakeholders are important for inclusive and sustainable partnerships. Such guidelines may take the form of a governance charter and can be a means for encouraging the participation and inclusion of stakeholders who may have little to no experience with research or are otherwise underrepresented in research. This perspective article presents the Stakeholder-Centric Engagement Charter (SCEC), one effort to operationalize a stakeholder engagement approach between researchers and an advisory committee as guided by the Patient-Centered Outcomes Research Institute's (PCORI) Research Engagement Principles (i.e., reciprocal relationships, partnerships, co-learning, transparency-honesty-trust). Building on the SCEC can help future investigators develop a study-specific, dynamic, governance document outlining advisory committee and research team preferences in areas such as role expectations, study governance, and decision-making procedures.
| S-EPMC8994015 | biostudies-literature
Project description:BackgroundUnderstanding how users engage with electronic screening and brief intervention (eSBI) is a critical research objective to improve effectiveness of app-based interventions to reduce harmful alcohol consumption. Although quantitative measures of engagement provide a strong indicator of how the user engages with an app at the group level, they do not elucidate finer-grained details of how apps function from an individual, experiential perspective and why, or how, users engage with an intervention in a particular manner.ObjectiveThe aim of this study was to (1) understand why and how participants engaged with the BRANCH app, (2) explore facilitators and barriers to engagement with app features, (3) explore how the BRANCH app impacted drinking behavior, (4) use these data to identify typologies of users of the BRANCH app in terms of engagement behaviors, and (5) identify future eSBI app design implications.MethodsIn total, 20 one-to-one semistructured telephone interviews were conducted with participants recruited from a randomized controlled trial, which evaluated the effectiveness of engagement-promoting strategies in the BRANCH app targeting harmful drinking in young adults (aged 18-30 years). The topic guide explored users' current engagement levels with existing health promotion apps, their views toward the effectiveness of such apps, and what they liked and disliked about BRANCH, specifically focusing on how they engaged with the app. Framework analysis was used to develop typologies of user engagement.ResultsThe study identified 3 typologies of engagers. Trackers were defined by their motivations to use health-tracking apps to monitor and understand quantified self-data. They did not have intentions necessarily to cut down and predominantly used only the drinking diary. Cut-downers were motivated to use the app because they wanted to reduce their alcohol consumption Unlike Trackers, they did not use a range of different health apps daily, but saw the BRANCH app as an opportunity to test out a different method of trying to cut down their alcohol use. This typology used more features than Trackers, such as the goal setting function. Noncommitters were characterized as a group of users who were initially enthusiastic about using the app; however, this enthusiasm quickly waned and they gained no benefit from it.ConclusionsThis was the first study to identify typologies of user engagement with eSBI apps. Although in need of replication, it provides a first step in understanding independent categories of eSBI users, who may benefit from apps tailored to a user's typology or motivation. It also provides new evidence to suggest that apps may be used more effectively as a tool to raise awareness of drinking, instead of reducing alcohol use, and be a step in the care pathway, identifying at-risk individuals and signposting them to more intensive treatment.Trial registrationInternational Standard Randomised Controlled Trial Number ISRCTN70980706; http://www.isrctn.com /ISRCTN70980706 (Archived by WebCite at http://www.webcitation.org/73vfDXYEZ).
| S-EPMC6315270 | biostudies-literature
Project description:BackgroundSleep problems are quite common among young children and are often a challenge for parents and a hinderance to children's development. Although behavioral therapy has proven effective in reducing sleep problems in children, a lack of access to professionals who can provide effective support is a major barrier for many caregivers. Therefore, pediatric sleep experts have begun developing apps and web-based services for caregivers. Despite the substantial influence of cultural and familial factors on children's sleep, little effort has gone into developing cultural or family-tailored interventions.ObjectiveThis study aimed to examine the effectiveness of the interactive smartphone app "Nenne Navi," which provides culturally and family-tailored suggestions for improving sleep habits in young Japanese children through community-based long-term trials. The study also aimed to investigate the association between app-driven improvements in sleep and mental development in children.MethodsThis study adopted a community-based approach to recruit individuals from the Higashi-Osaka city (Japan) who met ≥1 of the following eligibility criteria for sleep problems: sleeping after 10 PM, getting <9 hours of nighttime sleep, and experiencing frequent nighttime awakenings. A total of 87 Japanese caregivers with young children (mean 19.50, SD 0.70 months) were recruited and assigned to the app use group (intervention group) or the video-only group (control group). Both groups received educational video content regarding sleep health literacy. The caregivers in the intervention group used the app, which provides family-tailored suggestions, once per month for 1 year.ResultsA total of 92% (33/36) of the caregivers in the app use group completed 1 year of the intervention. The participants' overall evaluation of the app was positive. The wake-up time was advanced (base mean 8:06 AM; post mean 7:48 AM; F1,65=6.769; P=.01 and sleep onset latency was decreased (base mean 34.45 minutes; post mean 20.05 minutes; F1,65=23.219; P<.001) significantly in the app use group at the 13th month compared with the video-only group. Moreover, multiple regression analysis showed that decreased social jetlag (β=-0.302; P=.03) and increased sleep onset latency SD (β=.426; P=.02) in children predicted a significant enhancement in the development of social relationships with adults. At 6 months after the completion of the app use, all the caregivers reported continuation of the new lifestyle.ConclusionsThe present findings suggest that the app "Nenne Navi" has high continuity in community use and can improve sleep habits in young Japanese children and that interventions for sleep habits of young children may lead to the enhancement of children's social development. Future studies must focus on the effectiveness of the app in other regions with different regional characteristics and neuroscientific investigations on how changes in sleep impact brain development.
| S-EPMC9960041 | biostudies-literature
Project description:BackgroundCaregivers play a pivotal role in maintaining an economically viable health care system, yet they are characterized by low levels of psychological well-being and consistently report unmet needs for psychological support. Mobile app-based (mobile health [mHealth]) interventions present a novel approach to both reducing stress and improving well-being.ObjectiveThis study aims to evaluate the effectiveness of a self-guided mobile app-based psychological intervention for people providing care to family or friends with a physical or mental disability.MethodsIn a randomized, single-blind, controlled trial, 183 caregivers recruited through the web were randomly allocated to either an intervention (n=73) or active control (n=110) condition. The intervention app contained treatment modules combining daily self-monitoring with third-wave (mindfulness-based) cognitive-behavioral therapies, whereas the active control app contained only self-monitoring features. Both programs were completed over a 5-week period. It was hypothesized that intervention app exposure would be associated with decreases in depression, anxiety, and stress, and increases in well-being, self-esteem, optimism, primary and secondary control, and social support. Outcomes were assessed at baseline, postintervention, and 3-4 months postintervention. App quality was also assessed.ResultsIn total, 25% (18/73) of the intervention participants were lost to follow-up at 3 months, and 30.9% (34/110) of the participants from the wait-list control group dropped out before the postintervention survey. The intervention group experienced reductions in stress (b=-2.07; P=.04) and depressive symptoms (b=-1.36; P=.05) from baseline to postintervention. These changes were further enhanced from postintervention to follow-up, with the intervention group continuing to report lower levels of depression (b=-1.82; P=.03) and higher levels of emotional well-being (b=6.13; P<.001), optimism (b=0.78; P=.007), self-esteem (b=-0.84; P=.005), support from family (b=2.15; P=.001), support from significant others (b=2.66; P<.001), and subjective well-being (b=4.82; P<.001). On average, participants completed 2.5 (SD 1.05) out of 5 treatment modules. The overall quality of the app was also rated highly, with a mean score of 3.94 out of a maximum score of 5 (SD 0.58).ConclusionsThis study demonstrates that mHealth psychological interventions are an effective treatment option for caregivers experiencing high levels of stress. Recommendations for improving mHealth interventions for caregivers include offering flexibility and customization in the treatment design.Trial registrationAustralian New Zealand Clinical Trial Registry ACTRN12616000996460; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371170.
| S-EPMC7414413 | biostudies-literature
Project description:BackgroundChildhood obesity is an ongoing problem in developed countries that needs targeted prevention in the youngest age groups. Children in socioeconomically disadvantaged families are most at risk. Mobile health (mHealth) interventions offer a potential route to target these families because of its relatively low cost and high reach. The Growing healthy program was developed to provide evidence-based information on infant feeding from birth to 9 months via app or website. Understanding user engagement with these media is vital to developing successful interventions. Engagement is a complex, multifactorial concept that needs to move beyond simple metrics.ObjectiveThe aim of our study was to describe the development of an engagement index (EI) to monitor participant interaction with the Growing healthy app. The index included a number of subindices and cut-points to categorize engagement.MethodsThe Growing program was a feasibility study in which 300 mother-infant dyads were provided with an app which included 3 push notifications that was sent each week. Growing healthy participants completed surveys at 3 time points: baseline (T1) (infant age ≤3 months), infant aged 6 months (T2), and infant aged 9 months (T3). In addition, app usage data were captured from the app. The EI was adapted from the Web Analytics Demystified visitor EI. Our EI included 5 subindices: (1) click depth, (2) loyalty, (3) interaction, (4) recency, and (5) feedback. The overall EI summarized the subindices from date of registration through to 39 weeks (9 months) from the infant's date of birth. Basic descriptive data analysis was performed on the metrics and components of the EI as well as the final EI score. Group comparisons used t tests, analysis of variance (ANOVA), Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests as appropriate. Consideration of independent variables associated with the EI score were modeled using linear regression models.ResultsThe overall EI mean score was 30.0% (SD 11.5%) with a range of 1.8% - 57.6%. The cut-points used for high engagement were scores greater than 37.1% and for poor engagement were scores less than 21.1%. Significant explanatory variables of the EI score included: parity (P=.005), system type including "app only" users or "both" app and email users (P<.001), recruitment method (P=.02), and baby age at recruitment (P=.005).ConclusionsThe EI provided a comprehensive understanding of participant behavior with the app over the 9-month period of the Growing healthy program. The use of the EI in this study demonstrates that rich and useful data can be collected and used to inform assessments of the strengths and weaknesses of the app and in turn inform future interventions.
| S-EPMC5509951 | biostudies-literature
Project description:ObjectivesWhen monitoring patients over time, clinicians may struggle to distinguish 'real changes' in consecutive blood parameters from so-called natural fluctuations. In practice, they have to do so by relying on their clinical experience and intuition. We developed Labtracker+, a medical app that calculates the probability that an increase or decrease over time in a specific blood parameter is real, given the time between measurements.DesignWe presented patient cases to 135 participants to examine whether there is a difference between medical students, residents and experienced clinicians when it comes to interpreting changes between consecutive laboratory results. Participants were asked to interpret if changes in consecutive laboratory values were likely to be 'real' or rather due to natural fluctuations. The answers of the study participants were compared with the calculated probabilities by the app Labtracker+ and the concordance rates were assessed.Setting and participantsMedical students (n=92), medical residents from the department of internal medicine (n=19) and internists (n=24) at a Dutch University Medical Centre.Primary and secondary outcome measuresConcordance rates between the study participants and the calculated probabilities by the app Labtracker+ were compared. Besides, we tested whether physicians with clinical experience scored better concordance rates with the app Labtracker+ than inexperienced clinicians.ResultsMedical residents and internists showed significantly better concordance rates with the calculated probabilities by the app Labtracker+ than medical students, regarding their interpretation of differences between consecutive laboratory results (p=0.009 and p<0.001, respectively).ConclusionThe app Labtracker+ could serve as a clinical decision tool in the interpretation of consecutive laboratory test results and could contribute to rapid recognition of parameter changes by physicians.
| S-EPMC5589013 | biostudies-literature
Project description:BackgroundHome is a vulnerable place for accidental child injuries. Unintentional injuries are a leading cause of death, hospitalization, and disabilities. These injuries are considered preventable and if not tackled, they will continue to be a persisting problem. Smartphones have become increasingly important in our everyday life and is an important tool not only for communication but also for other purposes-they have apps that can be used for various purposes. Therefore, an app-based intervention (ChildSafe) was developed to assess and reduce child injury at home.ObjectiveThis study aimed to evaluate the acceptance of the ChildSafe smartphone app intervention by parents/guardians.MethodsThis study was conducted using a qualitative exploratory approach on selected participants of the ChildSafe intervention app study. A total of 27 semistructured in-depth interviews were carried out among parents or guardians who have at least one child between the age of 0 and 59 months in the area of Sungai Buloh, Selangor, between November 2017 and March 2018. Interview questions were developed from the consolidated framework for implementation research (CFIR). Interviews were recorded, transcribed verbatim, and data were thematically analyzed guided by CFIR.ResultsThe study revealed users' perception on usability, feasibility, and acceptability toward the ChildSafe app. Three CFIR domains were identified: intervention characteristics, inner setting, and characteristics of individuals. A total of 5 constructs were revealed under intervention characteristics: evidence strength and quality, relative advantage, adaptability, trialability, and design quality and packaging; 2 under inner setting: implementation climate and readiness for implementation; and 4 under characteristics of individuals: knowledge and beliefs about the intervention, self-efficacy, individual stage of change, and other personal attributes. In general, participants felt the app is extremely useful and effective, easy to use, and purposeful in achieving home safety assessment via reminders. The app replaces the need for participants to search for information on home safety and dangers, as the app itself was designed as a tool to assess for this specific purpose. Even at the nascent stage and despite its limitations, the app has prompted users to consider and make changes around their own home. However, future versions of the app should be expanded to make it more attractive to users as it lacks interactive feedback and additional features.ConclusionsParents/guardians are accepting the use of the ChildSafe app to prevent child injury at home. However, further expansion and improvements are needed to increase the acceptability of this app by parents/guardians.
| S-EPMC8207251 | biostudies-literature
Project description:BackgroundImpulsive processes driving eating behaviour can often undermine peoples' attempts to change their behaviour, lose weight and maintain weight loss.AimTo develop an impulse management intervention to support weight loss in adults.MethodsIntervention Mapping (IM) was used to systematically develop the "ImpulsePal" intervention. The development involved: (1) a needs assessment including a qualitative study, Patient and Public advisory group and expert group consultations, and a systematic review of impulse management techniques; (2) specification of performance objectives, determinants, and change objectives; (3) selection of intervention strategies (mapping of change techniques to the determinants of change); (4) creation of programme materials; (5) specification of adoption and implementation plans; (6) devising an evaluation plan.ResultsApplication of the IM Protocol resulted in a smartphone app that could support reductions in unhealthy (energy dense) food consumption, overeating, and alcoholic and sugary drink consumption. ImpulsePal includes inhibition training, mindfulness techniques, implementation intentions (if-then planning), visuospatial loading, use of physical activity for craving management, and context-specific reminders. An "Emergency Button" was also included to provide access to in-the-moment support when temptation is strong.ConclusionsImpulsePal is a novel, theory- and evidence-informed, person-centred app that aims to support impulse management for healthier eating. Intervention Mapping facilitated the incorporation of app components that are practical operationalisations of change techniques targeting our specific change objectives and their associated theoretical determinants. Using IM enabled transparency and provided a clear framework for evaluation, and enhances replicability and the potential of the intervention to accomplish the desired outcome of facilitating weight loss through dietary change.
| S-EPMC8637692 | biostudies-literature
Project description:BACKGROUND:Cancer patients transitioning to survivorship after completing cancer treatments need psychosocial interventions to manage stressors such as anxiety, depression, and fear of cancer recurrence. Mindfulness-based interventions (MBIs) are effective for treating these symptoms; however, cancer survivors are often unable to participate in face-to-face interventions because of difficulties such as work and family commitments, treatment-related side-effects, scheduling conflicts, and geography. Smartphone app-based MBIs are an innovative way to deliver psychosocial cancer care and can overcome several such difficulties, since patients can participate at their own convenience. OBJECTIVE:The SEAMLESS (Smartphone App-Based Mindfulness Intervention for Cancer Survivors) study aims to evaluate the efficacy of a tailored app-based mindfulness intervention for cancer survivors (the Am Mindfulness-Based Cancer Survivorship-MBCS-Journey) for treating (1) symptoms of stress (primary outcome), as well as (2) fear of cancer recurrence, anxiety, depression, fatigue, and overall physical functioning (secondary outcomes). This is the first Canadian efficacy trial of a tailored mindfulness app intervention in cancer survivors. METHODS:This is a randomized waitlist-controlled trial, which will evaluate the effectiveness of Am MBCS for impacting the primary and secondary outcomes in cancer survivors who have completed all their cancer treatments. Outcomes will be assessed using web-based surveys with validated psychometric instruments at (1) baseline, (2) mid-intervention (2 weeks later), (3) immediately postintervention (4 weeks), (4) 3 months postbaseline, (5) 6 months postbaseline, and (6) 12 months postbaseline. The waitlist group will complete all assessments and will cross over to the intervention condition after the 3-month assessment. In addition, data will be obtained by the smartphone app itself, which includes users' engagement with the app-based intervention, their emotional state (eg, angry and elated) from a user-inputted digital emotion-mapping board, and psychobiometric data using photoplethysmography technology. RESULTS:The study received ethics approval in September 2018 and recruitment commenced in January 2019. Participants are being recruited through a provincial cancer registry, and the majority of participants currently enrolled are breast (44/83, 53%) or colorectal (17/83, 20%) cancer survivors, although some survivors of other cancer are also present. Data collection for analysis of the primary outcome time-point will be complete by September 2019, and the follow-up data will be collected and analyzed by September 2020. Data will be analyzed to determine group differences using linear mixed modelling statistical techniques. CONCLUSIONS:Cancer care providers are uncertain about the efficacy of app-based mindfulness interventions for patients, which are available in great supply in today's digital world. This study will provide rigorously evaluated efficacy data for an app-based mindfulness intervention for cancer survivors, which if helpful, could be made available for psychosocial care at cancer centers worldwide. TRIAL REGISTRATION:ClinicalTrials.gov NCT03484000; https://clinicaltrials.gov/ct2/show/NCT03484000. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/15178.
| S-EPMC7248798 | biostudies-literature