Health technologies ‘In the wild’: experiences of engagement with computerised CBT

The widespread deployment of technology by professional health services will provide a substantial opportunity for studies that consider usage in naturalistic settings. Our study has documented experiences of engaging with technologies intended to support recovery from common mental health problems, often used as a part of a multi-year recovery process. In analyzing this material, we identify issues of broad interest to effective health technology design, and reflect on the challenge of studying engagement with health technologies over lengthy time periods. We also consider the importance of designing technologies that are sensitive to the needs of users experiencing chronic health problems, and discuss how the term sensitivity might be defined in a technology design context

Mental Health Recovery Narratives and Their Impact on Recipients: Systematic Review and Narrative Synthesis.

OBJECTIVE: Mental health recovery narratives are often shared in peer support work and antistigma campaigns. Internet technology provides access to an almost unlimited number of narratives, and yet little is known about how they affect recipients. The aim of this study was to develop a conceptual framework characterizing the impact of recovery narratives on recipients. METHOD: A systematic review of evidence about the impact of mental health recovery narratives was conducted. Searches used electronic databases ( n = 9), reference tracking, hand-searching of selected journals ( n = 2), grey literature searching, and expert consultation ( n = 7). A conceptual framework was generated through a thematic analysis of included articles, augmented by consultation with a Lived Experience Advisory Panel. RESULTS: In total, 8137 articles were screened. Five articles were included. Forms of impact were connectedness, understanding of recovery, reduction in stigma, validation of personal experience, affective responses, and behavioural responses. Impact was moderated by characteristics of the recipient, context, and narrative. Increases in eating disorder behaviours were identified as a harmful response specific to recipients with eating disorders. CONCLUSIONS: Mental health recovery narratives can promote recovery. Recovery narratives might be useful for clients with limited access to peers and in online interventions targeted at reducing social isolation in rural or remote locations, but support is needed for the processing of the strong emotions that can arise. Caution is needed for use with specific clinical populations. Protocol registration: Prospero-CRD42018090923

Computing and mental health:intentionality and reflection at the click of a button

Automated passive sensing applications and self-reported smart diaries seem to hold promise for the management of anxiety in autism and other mental health conditions. However, passive sensing often struggles with noisy data, ambiguous feedback and weak user agency over the device, whilst self-reporting relies on user-entered data which can be time consuming and cognitively demanding. To address these limitations, we explore a different approach, whereby individuals consciously actuate personal data capture and are in control of it at all times; yet, the interaction solely involves clicking a button, thus avoiding cognitive overload whilst supporting immediate reflection. We call this approach intentive computing. Through our initial investigations we found that conscious interactions cannot only provide real-time relief in anxiety management, but can also function as memory anchors irrespective of the content captured and even prior to data visualizatio

Computing and mental health:intentionality and reflection at the click of a button

Automated passive sensing applications and self-reported smart diaries seem to hold promise for the management of anxiety in autism and other mental health conditions. However, passive sensing often struggles with noisy data, ambiguous feedback and weak user agency over the device, whilst self-reporting relies on user-entered data which can be time consuming and cognitively demanding. To address these limitations, we explore a different approach, whereby individuals consciously actuate personal data capture and are in control of it at all times; yet, the interaction solely involves clicking a button, thus avoiding cognitive overload whilst supporting immediate reflection. We call this approach intentive computing. Through our initial investigations we found that conscious interactions cannot only provide real-time relief in anxiety management, but can also function as memory anchors irrespective of the content captured and even prior to data visualizatio

Empowering people to help speak up about safety in primary care: Using codesign to involve patients and professionals in developing new interventions for patients with multimorbidity.

BACKGROUND: Multimorbidity, defined as the presence of two or more long-term conditions, is increasingly common in primary care, and patients with multimorbidity may face particular barriers to quality of care and increased safety risks due to the complexity of managing multiple conditions. Consistent with calls to directly involve service users in improving care, we aimed to use design materials to codesign new interventions to improve safety in primary care. DESIGN: We drew on two established methods-accelerated experience-based codesign and the future workshop approach. We synthesized design materials based on research into the patient experience of safety and multimorbidity in primary care to enable both patients, service users and carers, and primary health-care professionals to propose interventions to improve care. RESULTS: Both patients and professionals prioritized polypharmacy as a threat to safety. Their recommendations for supportive interventions were consistent with Burden of Treatment theory, emphasizing the limited capacity of patients with multimorbidity and the need for services to proactively offer support to reduce the burden of managing complex treatment regimes. DISCUSSION & CONCLUSIONS: The process was feasible and acceptable to participants, who valued the opportunity to jointly propose new interventions. The iterative workshop approach enabled the research team to better explore and refine the suggestions of attendees. Final recommendations included the need for accessible reminders to support medication adherence and medication reviews for particularly vulnerable patients conducted with pharmacists within GP practices

A survey of the trajectories conceptual framework: investigating theory use in HCI

We present a case study of how Human-Computer Interaction (HCI) theory is reused within the field. We analyze the HCI literature in order to reveal the impact of one particular theory, the trajectories framework that has been cited as an example of both contemporary HCI theory and a strong concept that sits between theory and design practice. Our analysis of 60 papers that seriously engaged with trajectories reveals the purposes that the framework served and which parts of it they used. We compare our findings to the originally stated goals of trajectories and to subsequent claims of its status as both theory and strong concept. The results shed new light on what we mean by theory in HCI, including its relationship to practice and to other disciplines

Integrating the Digital and the Traditional to Deliver Therapy for Depression: Lessons from a Pragmatic Study

Traditional approaches to psychotherapy emphasise face-to-face contact between patients and therapists. In contrast, current computerised approaches tend to minimise this contact. This can limit the range of mental health difficulties for which computerised approaches are effective. Here, we explore an alternative approach that integrates face-to-face contact, electronic contact, online collaboration, and support for between-session activities. Our discussion is grounded in the design of a platform to deliver psychotherapy for depression. We report findings of an 11-month pragmatic study in which 17 patients received treatment for depression via the platform. Results show how design decisions had a significant impact on the dynamics of therapeutic sessions and the establishment of patient-therapist relationships. For example, the use of instant messaging for synchronous, in-session contact slowed communication, but also provided a valuable space for reflection and helped to maintain session focus. We discuss the impact of flexibility and the potential of integrated approaches to both enhance and reduce patient engagement

Men's views of antidepressant treatment for depression, and their implications for community pharmacy practice

BackgroundMen with depression can express and navigate their condition differently to women. Understanding this population's needs, and experiences, can help healthcare professionals better support these patients. There is a lack of knowledge in this area, and no studies have explored men's depression in the context of community pharmacy.ObjectivesExplore views of men around their medication for the treatment of depression and the role of community pharmacy in their treatment.SettingUnited Kingdom (UK) primary care.MethodSemi-structured in-depth interviews were conducted. Eligible participants were male, aged 18–65 years, and treating depression with antidepressants. Participants were recruited through 5 UK pharmacies (via the pharmacist or poster recruitment) and a UK University (poster recruitment). A thematic approach was used for analysis.Results14 men aged 26–61 years, predominantly of white ethnicity were interviewed. Key themes were found. The theme ‘Antidepressant's attributions to benefits' highlighted all men noticed benefits when taking antidepressants, but held uncertainty on what extent their antidepressants caused this. The themes ‘Views of pharmacist's role influences engagement’, and ‘Influence of cognitive state upon healthcare interactions’ demonstrated men were not inclined to discuss concerns with the community pharmacist. These men didn't see this as the pharmacist's role, nor had these men given cognitive space to evaluate their treatment beliefs or information needs. Yet the theme ‘Reflection of support and information needs’ shows men did have unmet information and support needs. This also links into the ‘Hegemonic Masculinity and taking antidepressants’ theme, where taking antidepressants could challenge ones masculinity.ConclusionCommunity pharmacists should create opportunities for men to engage in conversations around their antidepressants and wider support. Men, as a requisite for engagement, will need to see such interactions as within the community pharmacists’ remit, and as part of a collaborative healthcare system

Exploring and Designing for Memory Impairments in Depression

Depression is an affective disorder with distinctive autobiographical memory impairments, including negative bias, overgeneralization and reduced positivity. Several clinical therapies address these impairments, and there is an opportunity to develop new supports for treatment by considering depression-associated memory impairments within design. We report on interviews with ten experts in treating depression, with expertise in both neuropsychology and cognitive behavioral therapies. The interview explores approaches for addressing each of these memory impairments. We found consistent use of positive memories for treating all memory impairments, the challenge of direct retrieval, and the need to support the experience of positive memories. Our findings open up new design opportunities for memory technologies for depression, including positive memory banks for active encoding and selective retrieval, novel cues for supporting generative retrieval, and novel interfaces to strengthen the reliving of positive memories

Research into digital health intervention for mental health: a 25-year retrospective on the ethical and legal challenges

Digital mental health interventions are routinely integrated into mental health services internationally, and can contribute to the reduction of the global mental health treatment gap that has been identified by the World Health Organisation. Research teams designing and delivering evaluations frequently invest substantial effort in deliberating on ethical and legal challenges around digital mental health interventions. In this article, we reflect on our own research experience of digital mental health intervention design and evaluation to identify eight of the most critical challenges that we or others have faced, and that have ethical or legal consequences. These are: 1) Harm caused by online recruitment work; 2) Monitoring of intervention safety; 3) Exclusion of specific demographic or clinical groups; 4) Inadequate robustness of effectiveness and cost-effectiveness findings; 5) Adequately conceptualising and supporting engagement and adherence; 6) Structural barriers to implementation; 7) Data protection and intellectual property; and 8) Regulatory ambiguity relating to digital mental health interventions that are medical devices. As we describe these challenges, we have highlighted serious consequences that can or have occurred, such as substantial delays to studies if regulations around Software as a Medical Device are not fully understood, or if regulations change substantially during the study lifecycle. Collectively, the challenges that we have identified highlight a substantial body of knowledge and expertise that is required, either within the team, or through access to external experts. Ensuring access to expertise requires careful planning, and adequate financial resources, for example to pay public contributors to engage debate on critical ethical issues, or to pay for legal opinions on regulatory issues. Access to such resources can be planned for on a per-study basis, and enabled through funding proposals. However, organisations regularly engaged in the development and evaluation of digital mental health interventions should consider creating or supporting structures such as advisory groups who can retain necessary competences, such as in medical devices regulation