Designing a Mobile Application to Support the Indicated Prevention and Early Intervention of Childhood Anxiety

This paper presents the design of an mHealth application for prevention and early intervention of childhood anxiety. The application is based on REACH, a preventative-early intervention protocol for childhood anxiety. This paper describes the multidisciplinary design process, sharing lessons learned in developing an effective mHealth application. This mHealth application is unique due to participant age, preventive-early intervention focus, and utilization of mobile technology in a situated manner. A design process inspired by user-centered leveraging key informant interviews was used to identify application features, including game based strategies and an animated motivational avatar. Validation was performed through external review and a usability study performed with target end users of the application. Results suggest overall satisfaction, ease of use, and increased motivation

Usability of a Smartphone Application to Support the Prevention and Early Intervention of Anxiety in Youth

Anxiety disorders are among the most common psychiatric problems in youth, fail to spontaneously remit, and place some youth at risk for additional behavioral and emotional difficulties. Efforts to target anxiety have resulted in evidence-based interventions but the resulting prevention effects are relatively small, often weakening over time. Mobile health (mHealth) tools could be of use to strengthen the effects of anxiety prevention efforts. Although a large number of mHealth apps have been developed, few have been evaluated in terms of usability prior to clinical effectiveness testing. Because usability is one of the main barriers to mHealth usage and adoption, the objective of this research was to evaluate the usability of a smartphone application (app) corresponding to an indicated prevention and early intervention targeting youth anxiety. To accomplish this, 132 children (M age = 9.65; 63% girls) and 45 service providers (M age = 29.13, 87% female) rated our app along five established dimensions of usability (ease of use, ease of learning, quality of support information, satisfaction, and stigma) using a standardized group-based testing protocol. Findings showed that the app was highly and positively rated by both youth and providers, with some variations (lower ratings when errors occurred). Path analyses findings also showed that system understanding was significantly related to greater system satisfaction, but that such relation occurred through the quality of support information offered by the app

Utilization of Media-Driven Technology for Health Promotion and Risk Reduction among American Indian and Alaska Native Young Adults: An Exploratory Study

Across the developmental spectrum, American Indian and Alaska Native (AI/AN) adolescents and young adults experience considerable behavioral and mental health disparities, including substance abuse, depression, and engagement in sexual behaviors which enhance risk of pregnancy and sexually transmitted infections. Health-focused interventions utilizing digital and media technology hold significant promise among tribal communities, as they have the capacity to eliminate geography-based barriers. Utilizing a sample of 210 self-identified AI/AN students attending tribal colleges, this study identified the most effective technologies and intervention strategies, as well as health seeking patterns and preferences, which may impact implementation and sustainable use in tribal settings. The use of technology was both diverse and pervasive among AI/AN young adults, mirroring or exceeding patterns of young adults from the broader population. These data suggest that technology-based interventions may effectively deliver information, resources, and behavior change tools to AI/AN young adults, particularly when reflecting their unique worldviews and social contexts

Adaptive mHealth Interventions for Improving Youth Responsiveness and Clinical Outcomes

abstract: Mobile health (mHealth) applications (apps) hold tremendous potential for addressing chronic health conditions. Smartphones are now the most popular form of computing, and the ubiquitous “always with us, always on” nature of mobile technology makes them amenable to interventions aimed and managing chronic disease. Several challenges exist, however, such as the difficulty in determining mHealth effects due to the rapidly changing nature of the technology and the challenges presented to existing methods of evaluation, and the ability to ensure end users consistently use the technology in order to achieve the desired effects. The latter challenge is in adherence, defined as the extent to which a patient conducts the activities defined in a clinical protocol (i.e. an intervention plan). Further, higher levels of adherence should lead to greater effects of the intervention (the greater fidelity to the protocol, the more benefit one should receive from the protocol). mHealth has limitations in these areas; the ability to have patients sustainably adhere to a protocol, and the ability to drive intervention effect sizes. My research considers personalized interventions, a new approach of study in the mHealth community, as a potential remedy to these limitations. Specifically, in the context of a pediatric preventative anxiety protocol, I introduce algorithms to drive greater levels of adherence and greater effect sizes by incorporating per-patient (personalized) information. These algorithms have been implemented within an existing mHealth app for middle school that has been successfully deployed in a school in the Phoenix Arizona metropolitan area. The number of users is small (n=3) so a case-by-case analysis of app usage is presented. In addition simulated user behaviors based on models of adherence and effects sizes over time are presented as a means to demonstrate the potential impact of personalized deployments on a larger scale.Dissertation/ThesisMasters Thesis Software Engineering 201

“I just let him cry...”: Designing socio-technical interventions in families to prevent mental health disorders

Interventions that help children develop protective factors against mental health disorders are an inherently social endeavour, relying on a number of actors from within the family as well as the school context. Little work thus far in CSCW and HCI has examined the potential of technology to support or enhance such interventions. This paper provides the first steps to unpacking this socio-technical design space, focusing on emotional regulation (ER) as a specific instance of a protective factor. We combine a user-centred approach to understanding lived experiences of families (interviews, design workshops) with an expert-led understanding of what makes interventions psychologically effective. Our findings suggest the potential of technology to enable a shift in how prevention interventions are designed and delivered: empowering children and parents through a new model of ‘child-led, situated interventions’, where participants learn through actionable support directly within family life, as opposed to didactic in-person workshops and a subsequent ‘skills application’. This conceptual model was then instantiated in a technology probe, which was deployed with 14 families. The promising field study findings provide an initial proof-of-concept validation of the proposed approach

Mobile Health Technology Development: Adaptations for Children and Adolescents with Autism

Mobile health technology is a growing health resource that is usually designed for the general population. The existing literature on children and adolescents with autism suggests that their experience with mobile health technology may differ from the general population due to the coexisting conditions and social determinants of health related to autism. These differences can impact the anticipated effectiveness of mobile health technology. The goal of this qualitative study was to learn more about the experience of children and adolescents with autism with mobile health technology by interviewing health care providers, individuals who have autism, and parents of children with autism. The existing literature along with the personal experiences and recommendations discussed during these interviews provide a variety of considerations for mobile health technology developers. By incorporating these findings into new and existing mobile health technology, these resources can be more accessible and beneficial for children and adolescents with autism

Interdisciplinary Development of a Transdiagnostic Mobile App to Enhance Children’s Emotion Regulation: Sharing Insights and Lessons Learned

Background: Digital interventions, including mobile apps represent promising means to provide effective mental health support to young people. Despite the increased availability of mental health apps, there is a significant gap for this age group, especially for younger children. Research investigating the effectiveness and development process of child mental health apps is limited, and the field faces persistent issues in relation to low user up-take and engagement, which is assumed to be a result of lacking interdisciplinary approaches. // Objective: We present the development and design process of a new mental health app for children that targets their emotion regulation abilities. We describe the creation of a new interdisciplinary development framework, to guide the design process, and explain how each activity informed different app features. // Methods: The first two stages of the framework employed a variety of methods, including: 1) classroom observations, 2) public-engagement events with the target group (N=21), 3) synthesis of the existing evidence as part of a meta-analysis, 4) a series of co-design and participatory workshops with young users (N=33), clinicians (N=7), researchers (N=12), app developers (N=1) , designers (N=2), and lastly 5) testing of the first high-tech prototype (N=15). // Results: For the interdisciplinary framework we drew on methods derived from the medical research council framework for complex interventions, the patient-clinician-framework and Druin’s cooperative inquiry. The classroom observations, public-engagement events, and synthesis of the existing evidence informed the first key pillars of the app and wireframes. Subsequently, a series of workshops shaped and reshaped the content and app features, including games, psychoeducational films, and practice modules. Based on the prototype testing sessions we made further adjustments to improve the app. // Conclusions: Although mobile apps could be highly suitable to support young people’s mental health on a wider scale, there is little guidance on how these interventions could be designed. The involvement of the different methods and especially the young users was very valuable. We hope that the interdisciplinary framework and multiple methods that we applied will be helpful to others who are also aiming to develop suitable apps for young peopl

Emotion and coping in young victims of peer-agression

Peer-aggression and peer-victimization have been the subject of considerable research interest over the past quarter century. There has been a focus on perpetrators of violence and aggression, based upon the belief that clarification of group and individual processes underpinning aggression will lead to effective intervention and prevention strategies. However, while it is unrealistic to hope that we can completely eradicate aggression, only by clarifying why children and young people respond in certain ways when confronted by peer-aggression can we effectively and efficiently help them to help themselves. In this way, young people can be taught resilience and practical coping skills which will help them to deal with peer-aggression when it occurs, and they can also be helped to more effectively manage emotional reactions when involved in ongoing peer-victimization. Transactional coping theory (Lazarus, 1999) provides an excellent framework for clarifying the important pathways leading to individual differences in emotional reactions and the use of coping strategies by children and young people. In the present chapter, we review the research with victims of peer-aggression which has touched on these questions, and follow this with review of relevant studies from the stress and coping literature which shed light on the relationships between appraisals, emotions and coping strategies. We also report results from a study of our own examining these variables in a sample of children and adolescents experiencing peer-aggression, and draw conclusions for theory and practice based upon these

Smartphone apps for mindfulness interventions with suicidality in Asian youths: literature review

Background: The advent of mobile technology has ushered in an era where smartphone applications can be used for intervention for suicidality. Objective: Review recent research relevant to smartphone application that can be used for mindfulness intervention for suicidality in Asian youths. Methods: The inclusion criteria for this review is papers published in peer reviewed journals from 2007 to 2017 with usage of search terms namely ‘smartphone application’, and ‘mindfulness’, assessed against the inclusion criteria and screened by an experienced Asian clinician to be of clinical utility for mindfulness intervention for suicidality with Asian youths. Results: Initial search on databases yielded 375 results. 14 Full text papers that fit the inclusion criteria were assessed for eligibility and 10 papers were included in the current review. Conclusions: This review highlighted the paucity of evidence-based and empirically validated research into effective smartphone applications that can be used for mindfulness interventions for suicidality with Asian youths