Application of Smartphone Technology in the Management and Treatment of Mental Illnesses

Abstract: Background: Mental illness continues to be a significant Public Health problem and the innovative use of technology to improve the treatment of mental illnesses holds great public health relevance. Over the past decade telecommunications technology has been used to increase access to and improve the quality of mental health care. There is current evidence that the use of landline and cellular telephones, computer-assisted therapy, and videoconferencing can be effective in improving treatment outcomes. Smartphones, as the newest development in communications technology, offer a new opportunity to improve mental health care through their versatile nature to perform a variety of functions. Methods: A critical literature review was performed to examine the potential of smartphones to increase access to mental health care, reduce barriers to care, and improve patient treatment outcomes. The review was performed by searching several electronic databases using a combination of keywords related to smartphones and mental health interventions using mobile devices. Literature concerning the use of cell phones, handheld computers, and smartphones to improve access to mental health care and improve treatment outcomes was identified.Results: The majority of studies identified were feasibility and pilot studies on patients with a variety of diagnosed mental illnesses using cell phones and PDAs. Authors report that most study participants, with some exceptions, were capable of using a mobile device and found them acceptable to use. Few studies extensively measured treatment outcomes and instead reported preliminary results and presented case illustrations. Studies which used smartphones successfully used them collect data on patients and deliver multimedia interventions. Discussion: The current literature offers encouraging evidence for the use of smartphones to improve mental health care but also reflects the lack of research conducted using smartphones. Studies which examine care provider use of smartphones to improve care is encouraging but has limited generalizability to mental health care. The feasibility of patient use of smartphones is also encouraging, but questions remain about feasibility in some sub-populations, particularly schizophrenia patients. Pilot testing of mobile devices and applications can greatly increase the feasibility of using smartphones in mental health care. Patients who are unfamiliar with smartphones will likely need initial training and support in their use. Conclusion: The literature identified several ways in which smartphones can increase access to care, reduce barriers, and improve treatment outcomes. Study results were encouraging but scientifically weak. Future studies are needed replicating results of studies using cell phones and PDAs on smartphones. Larger and higher quality studies are needed to examine the feasibility, efficacy, and cost-effectiveness of smartphones to deliver multiple component interventions that improve access to mental health care and improve treatment outcomes

Feasibility of a mobile and web-based intervention to support self-management in outpatients with cancer pain

Purpose: Cancer pain is a prevalent and distressing symptom. To enhance self-management in outpatients, a multi-component intervention was developed, integrating patient self-management and professional care through healthcare technology. This article describes feasibility of the intervention in everyday practice. Method: Patients with moderate to severe cancer pain (n = 11) and registered nurses specialized in pain and palliative care (n = 3) participated in a four-week study. The intervention involved daily monitoring, graphical feedback, education, and advice by means of a mobile application for patients and a web application for nurses. Learnability, usability and desirability were measured in patients with a 20-item questionnaire (1–5 scale), higher scores indicating better feasibility. Patients' adherence was based on completion rates from server logs. Single semi-structured interviews with patients and a focus group interview with nurses provided insight into experiences. Results: Questionnaire findings confirmed learnability (4.8), usability (4.8) and desirability (4.6) of the application for patients. Average completion rates were 76.8% for pain monitoring, 50.4% for medication monitoring and 100% for education sessions. Interviews revealed that patients were pleased with the simplicity of the mobile application and appreciated different components. Nurses agreed upon the added value and were mostly positive about the possibilities of the web application. Patients and nurses provided ideas for improvements relating to the content and technical performance of the intervention. Conclusions: Study results demonstrate feasibility of the intervention in everyday practice. Provided that content-related and technical adjustments are made, the intervention enables patients with cancer pain to practice self-management and nurses to remotely support these patients

Impact of Mobile and Wireless Technology on Healthcare Delivery services

Modern healthcare delivery services embrace the use of leading edge technologies and new scientific discoveries to enable better cures for diseases and better means to enable early detection of most life-threatening diseases. The healthcare industry is finding itself in a state of turbulence and flux. The major innovations lie with the use of information technologies and particularly, the adoption of mobile and wireless applications in healthcare delivery [1]. Wireless devices are becoming increasingly popular across the healthcare field, enabling caregivers to review patient records and test results, enter diagnosis information during patient visits and consult drug formularies, all without the need for a wired network connection [2]. A pioneering medical-grade, wireless infrastructure supports complete mobility throughout the full continuum of healthcare delivery. It facilitates the accurate collection and the immediate dissemination of patient information to physicians and other healthcare care professionals at the time of clinical decision-making, thereby ensuring timely, safe, and effective patient care. This paper investigates the wireless technologies that can be used for medical applications, and the effectiveness of such wireless solutions in a healthcare environment. It discusses challenges encountered; and concludes by providing recommendations on policies and standards for the use of such technologies within hospitals

Assessment of Heart Failure Patients' Interest in Mobile Health Apps for Self-Care: Survey Study.

BackgroundHeart failure is a serious public health concern that afflicts millions of individuals in the United States. Development of behaviors that promote heart failure self-care may be imperative to reduce complications and avoid hospital re-admissions. Mobile health solutions, such as activity trackers and smartphone apps, could potentially help to promote self-care through remote tracking and issuing reminders.ObjectiveThe objective of this study was to ascertain heart failure patients' interest in a smartphone app to assist them in managing their treatment and symptoms and to determine factors that influence their interest in such an app.MethodsIn the clinic waiting room on the day of their outpatient clinic appointments, 50 heart failure patients participated in a self-administered survey. The survey comprised 139 questions from previously published, institutional review board-approved questionnaires. The survey measured patients' interest in and experience using technology as well as their function, heart failure symptoms, and heart failure self-care behaviors. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was among the 11 questionnaires and was used to measure the heart failure patients' health-related quality of life through patient-reported outcomes.ResultsParticipants were aged 64.5 years on average, 32% (16/50) of the participants were women, and 91% (41/45) of the participants were determined to be New York Heart Association Class II or higher. More than 60% (30/50) of the survey participants expressed interest in several potential features of a smartphone app designed for heart failure patients. Participant age correlated negatively with interest in tracking, tips, and reminders in multivariate regression analysis (P<.05). In contrast, MLHFQ scores (worse health status) produced positive correlations with these interests (P<.05).ConclusionsThe majority of heart failure patients showed interest in activity tracking, heart failure symptom management tips, and reminder features of a smartphone app. Desirable features and an understanding of factors that influence patient interest in a smartphone app for heart failure self-care may allow researchers to address common concerns and to develop apps that demonstrate the potential benefits of mobile technology

Technology-Based Interventions in Schizophrenia Patients : A Narrative Review

Aims: The development of technology to facilitate the management of schizophrenia is still very limited so that many people don’t know the benefits and efficacy of using technology as an intervention in schizophrenia patients. Objective:This literature review aimed to describe and determine the efficacy and benefits of using the technology used in schizophrenia patients. Method: The method used was a narrative review by combining articles from the PubMed, EbscoHost, Taylor and Francis, and Google Shcolar databases. The keywords used were “adults” OR “middle aged” AND “telenursing” OR “telemedicine” OR “telehealth” AND “schizophrenia patient”. Result: From these 6 articles, it was founde that there were several perceived benefits of using technology as an additional intervention, such as medication adherence, involvement in recovery and symptom control, and early detection of cognitive function in schizophrenic patients. Conclusion: Interventions using technology such as telehealth, telenursing, and telemedicine can be supportive interventions for the care of schizophrenic patients, especially to assist recovery or rehabilitation. Nursing Implications: The existence of this study can provide an overview to nurses regarding what technology-based support interventions can be given to schizophrenic patients along with their benefits

Comprehensive evaluation of interventions: eight vital parameters

Background It is critically important to determine the effectiveness of an intervention before it can be translated into clinical practice. However, the future implementation and sustainability of the intervention may be diminished if other intervention parameters are not assessed. This requires obtaining feedback from intervention recipients so interventions will be perceived as appealing, relevant, meaningful and beneficial to them; otherwise recipients may be unlikely to perform them over time, resulting in unsuccessful health outcomes. Aim To propose the addition of two intervention parameters to the existing six-parameter model and provide examples from recent research of how each parameter can be tested. Discussion Definitions of the eight parameters are provided and methods for analysing each of them explained. While some studies show necessity, fidelity and cost have unique distinguishing characteristics, other studies indicate feasibility, acceptability and safety have common features, and efficacy and effectiveness are closely associated. Conclusion Researchers frequently examine one or two parameters, but few simultaneously apply the six-parameter model. This model is also missing two vital parameters – efficacy and cost. Implications for practice Comprehensive and systematic evaluation of all eight intervention parameters is recommended before researchers begin randomised controlled trials and translate them into practice

Diabetes Management Self-Helper Mobile Application for Malaysian Type 2 Diabetes Patients

Diabetes is worldwide epidemic that is included projected to be 7 th highest death cause by 2030. WHO updated in March 2013 that 347 million people around the world are affected by diabetes. To improvise diabetics’ self-management, self-help mobile health applications are introduced for smartphones users around the world to help them in managing the disease effectively and efficiently. However, studies show that these applications are lacking in many areas and specifically in Malaysia, the existence of applications that are made for local type 2 diabetes patients is negligible as most of them are made overseas, hence do not really take specific lifestyle patterns of Malaysians into account

Mental Health Service Users\u27 Mobile Phone Contact Method: Preference and Medication Adherence

Research suggests that medication adherence among individuals with mental health problems is problematic. The issue of medication non-adherence among this population is consistent among the different mental health diagnoses. Numerous factors contribute to medication non-adherence: patient issues, service delivery issues, and issues related to the measurement of medication adherence, which lacks a gold standard. This dissertation is a compendium of three manuscripts that represent three distinct but related studies on medication adherence among individuals with mental health challenges. The first manuscript is an integrative review that seeks to assess the validity, reliability, and levels of evidence of existing instruments for measuring medication adherence in patients with schizophrenia. The second is another integrative review that examines literature in the past decade (2006-2016) on the use of mobile phone contacts (MPC) in individuals with severe mental illness to improve medication adherence after hospital discharge. The third, a descriptive correlational study, examines mental health services (MHS) users’ preferred MPC delivery method when receiving support to increase medication adherence after discharge. The findings from the first integrative review show the importance of validating medication adherence measures in this population. Findings from the second show the extent to which MPC support the increase of medication adherence in this population. Findings from the third show the importance of identifying patients’ preferences for an MPC method when providing support to increase medication adherence in this population. The findings of the two integrative reviews and the descriptive correlational study are integrated at the conclusion of the dissertation

Development of a Smartphone Application to Enable Remote Monitoring in the Outpatient Management of Cirrhotic Ascites

Patients who develop hepatic decompensation with ascites have a poor prognosis and often experience other complications including spontaneous bacterial peritonitis, hepatic encephalopathy and variceal bleeding. We hypothesised that smartphone (SP)-enabled remote monitoring of patients with ascites may enable early detection of infection and acute decompensation, facilitate timely intervention and improve patient outcomes. Aim:  We aimed to design, develop and implement a remote monitoring system (RMS) for outpatients with cirrhotic ascites. Method: We undertook surveys with patients and hepatologists to quantify the demand for a RMS and identify issues regarding implementation. A smartphone and a web-based application were developed as a RMS. Patients used the RMS in a 6-week prospective non-randomised trial.  Results: We surveyed 27 patients (mean age 56 years, 18 (67%) were male, 16 (59%) had Childs Pugh B cirrhosis, and 20 (74%) had a history of alcoholic liver disease) and 5 hepatologists. There were 19 patients (70%) who reported that they would use a RMS. The RMS was used by 10 patients for a mean 53.8days (11-70), who entered 20.6 (0-71) updates. A total of 18 automated alerts occurred. 22% of automated alerts resulted in clinically significant changes to management, such as inpatient admission n=1 (6%), early outpatient appointment n=1 (6%) and reinforced adherence n=2 (11%). Conclusion:   We have successfully designed an internet-enabled RMS for outpatients with cirrhotic ascites that could be used as an adjunct to existing outpatient services. Future studies will optimise the alert thresholds, assess long-term patient adoption and quantify clinical impact