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

Electronic swallowing intervention package to support swallowing function in patients with head and neck cancer: development and feasibility study

Background: Many patients undergoing treatment for head and neck cancer (HNC) experience significant swallowing difficulties, and there is some evidence that swallowing exercises may improve outcomes, including quality of life. This feasibility study developed an evidence-based, practical Swallowing Intervention Package (SiP) for patients undergoing chemo-radiotherapy (CRT) for HNC. As part of the study, an electronic version of SiP (e-SiP) was concurrently developed to support patients to self-manage during treatment. This paper reports on the e-SiP component of this work. Objective: To develop and conduct preliminary evaluation of an electronic support system (e-SiP) for patients undergoing CRT for head and neck cancer. Methods: The study involved health professionals and patients who were undergoing CRT for head and neck cancer. The scoping stage of e-SiP development involved investigated the potential usefulness of e-SiP, exploring how e-SiP would look and feel and what content would be appropriate to provide. Patient and carer focus groups and a health professionals’ consensus day were used as a means of data gathering around potential e-SiP content. A repeat focus group looked at an outline version of e-SIP and informed the next stage of its development around requirements for tool. This was followed by further development and a testing stage of e-SiP involved the coding of a prototype which was then evaluated using a series of steering group meetings, semi-structured interviews with both patients and health care professionals, and analysis of e-SiP log data. Results: Feedback from focus groups and health professional interviews was very positive and it was felt e-SiP use would support and encourage patients in conducting their swallowing exercises. However, of the ten patients offered e-SIP, only two opted to use it. For these patients, aspects of the e-SIP application were considered useful, in particular the ease of keeping a diary of exercises performed. Interviews with users and non-users suggested significant barriers to its use. Most significantly the lack of flexibility of platform on which e-SiP could be accessed appeared a dominant factor in deterring e-SiP use. Conclusions: Results suggest a need for further research to be conducted around the implementation of e-SiP. This involves evaluating how e-SiP can be better integrated into usual care, and through patient training and staff engagement, can be seen as a beneficial tool to help support patients in conducting swallowing exercises

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

a randomized controlled trial

학위논문(박사) -- 서울대학교대학원 : 의과대학 의과학과, 2021.8. 최형진.Background - Since lifestyle modification is the cornerstone of the obesity treatment, digital therapeutics (DTx) became one of the compelling and easily accessible treatment modalities. Objective - This research proposes to validate the treatment efficacy, understand behavioral changes by eating behavioral analysis, identify the predictive digital phenotypes for engagement and clinical outcomes, and examine genetic precision medicine of a novel digital therapeutic for obesity (dCBT-O). Method – This was an open-label, active-comparator, randomized controlled trial. Seventy female participants with body mass index (BMI) scores above 24kg/m² and no clinical problems besides obesity were randomized into experimental and control groups. The experimental group (dCBT-O group; 45 participants) was connected with a therapist intervention using a digital healthcare service that provided daily feedback and assignments for 8 weeks. The control group (25 participants) also used the digital healthcare service but practiced self-care without therapist intervention. Regarding the validating treatment efficacy, the primary outcomes of this study were objectively measured: weight in kg as well as other body compositions at 0, 8, and 24 weeks. Also, several eating behavioral phenotypes were assessed by buffet test-meal and food diary in app to examine the healthy behavioral change. Regarding the predictors for treatment efficacy, multidimensional digital phenotypes within time-series data were analyzed by elastic net regression method and obesity-related SNPs were genotyped from dCBT-O group. Result – Both weight (–3.1%, SD 4.5, vs –0.7%, SD 3.4; p = 0.036) and fat mass (–6.3%, SD 8.8, vs –0.8%, SD 8.1; p = 0.021) reduction at 8 weeks in the dCBT-O group were significantly higher than in the control group. Applying the machine learning approach, sixteen types of digital phenotypes (i.e., lower intake of high calorie food and evening snack, higher interaction frequency with mentors) predicted engagement rates, thirteen different digital phenotypes (i.e., lower intake of high calorie food and carb, higher intake of low calorie food) predicted the short-term weight change, and eight measures of digital phenotypes (i.e., lower intake of carb and evening snack, higher motivation) predicted the long-term weight change. The dCBT-O was also successful in promoting healthy eating behaviors that led to physiological and psychological adjustment for the metabolic mechanisms and consequences of healthy eating behavior. Lastly, CETP and APOA2 SNPs were significantly associated with the change in BMI (p = 0.028 and p = 0.005, respectively) at 24 weeks and eating behavioral phenotypes (p = 0.007 for healthy diet diversity and p = 0.036 for healthy diet proportion, respectively), the clinical efficacy markers of this study. Conclusion – These findings confirm that the multidisciplinary approach via digital modalities enhances the clinical efficacy of digital-based interventions for obesity. Moreover, it contributes to better understand the mechanisms of human eating behavior related to weight control. This line of research may shed light on the development of advanced prevention and personalized digital therapeutics.비만은 대표적인 생활습관 질병으로 알려져 있다. 따라서, 효과적인 비만 치료를 위해서는 다차원적인 치료적 접근이 중요시되는데, 디지털 치료제(Digital Therapeutics; DTx)는 이러한 접근에 최적화 되어있다. 본 연구의 목적은 새로 개발한 비만 디지털 치료제의 효과를 임상적 지표들과 섭식 행동 표현형들의 변화를 기반으로 검증하며, 치료적 순응도와 효과성을 예측할 수 있는 디지털 표현형들과 유전형들을 탐색하는 것이다. 본 연구에서는 BMI 24 이상, 기타 임상적인 증상을 보이지 않는 70명의 2-30대 여성들을 대상으로 대조군 대비 비만 디지털 치료제군(Digital Therapeutic for Obesity; dCBT-O군)에 1:2 비율의 무작위배정 임상시험을 시행하였다. dCBT-O군의 비만 치료는 임상심리학 전공 및 디지털 헬스케어 전문가가 8주 동안 진행하였으며, 24주차에는 치료 후 경과에 대한 평가를 실시하였다. 비만 디지털 치료제 효과 검증의 주요 지표는 체중을 비롯한 다양한 신체 계측 지표들의 변화이다. 이차 지표는 뷔폐실험과 모바일 어플리케이션 내 식단기록에서 수집된 섭식행동 표현형들을 기반으로 건강한 섭식행동 변화이다. 치료 순응도 및 효과 예측 인자들을 발굴하기 위해서는 다차원적인 시계열 디지털 표현형들을 머신러닝 기법으로 분석하였다. 그리고, 치료 반응 수준을 예측하는 유전형들을 찾기 위해 단일염기다형(Single Nucleotide Polymorphisms; SNP) 분석을 시행하였다. 본 연구의 주요 결과로 첫째, 8주간 치료 직후 dCBT-O군의 체중 변화가 대조군의 체중 변화에 비해 유의미하게 감량하였으며, 치료 종료 후 24주차도 체중이 감량 및 유지되었다. 둘째, dCBT-O군의 섭식행동이 대조군의 섭식행동에 비해 유의미하게 건강한 섭식행동으로 증진되었다. 셋째, 머신러닝 분석의 결과 16가지 디지털 표현형들이 치료적 순응도를 예측하고, 13가지 디지털 표현형들이 단기적인 치료효과를 예측하며, 8가지 디지털 표현형들이 장기적인 치료효과를 예측하였다. 마지막으로, CETP와 APOA2 SNP 유전형들이 신체계측 변화와 섭식행동변화와 유의미한 상관을 보였다. 본 연구는 디지털 기술을 활용한 다학제적인 접근이 비만 디지털 치료제의 임상 효과를 향상시킨다는 것을 보여준다. 또한 다차원적인 분석을 통해 체중 조절과 관련된 인간의 섭식 행동의 메커니즘을 더 잘 이해하는 데 기여한다. 본 연구는 첨단 예방의학과 정밀의학을 위한 디지털 치료제 개발에 중요한 패러다임을 제시할 것이다.Chapter 1. Introduction 1 Part I. Validating the treatment efficacy and finding its predictive markers: development of a dCBT-O 6 Part II. Eating behavioral analysis using buffet test-meal and food diary in app: understanding human eating behavior change by dCBT-O 8 Part III. Digital phenotyping using machine-learning analysis: identifying a predictive model for engagement in application and clinical outcomes of dCBT-O 11 Part IV. Genetic analysis for predicting the clinical responses: genetic precision medicine of dCBT-O 14 Chapter 2. Method 19 Chapter 3. Results 40 Chapter 4. Discussion 75 Perspectives A. Main issues related to DTx for obesity and eating behavior problems 91 Perspectives B. Limitations of DTx being applied in the clinics 96 Perspectives C. Future perspectives and recommendations 96 Chapter 5. Conclusion 99 Bibliography 100 Abstract in Korean 118 Acknowledgement 120박

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

Mobile Phone Apps for Quality of Life and Well-Being Assessment in Breast and Prostate Cancer Patients: Systematic Review

Background: Mobile phone health apps are increasingly gaining attention in oncological care as potential tools for supporting cancer patients. Although the number of publications and health apps focusing on cancer is increasing, there are still few specifically designed for the most prevalent cancers diagnosed: breast and prostate cancers. There is a need to review the effect of these apps on breast and prostate cancer patients’ quality of life (QoL) and well-being. Objective: The purposes of this study were to review the scientific literature on mobile phone apps targeting breast or prostate cancer patients and involving QoL and well-being (anxiety and depression symptoms) and analyze the clinical and technological characteristics, strengths, and weaknesses of these apps, as well as patients’ user experience with them. Methods: We conducted a systematic review of peer-reviewed literature from The Cochrane Library, Excerpta Medica Database, PsycINFO, PubMed, Scopus, and MEDLINE to identify studies involving apps focused on breast and/or prostate cancer patients and QoL and/or well-being published between January 1, 2000, and July 12, 2017. Only trial studies which met the inclusion criteria were selected. The systematic review was completed with a critical analysis of the apps previously identified in the health literature research that were available from the official app stores. Results: The systematic review of the literature yielded 3862 articles. After removal of duplicates, 3229 remained and were evaluated on the basis of title and abstract. Of these, 3211 were discarded as not meeting the inclusion criteria, and 18 records were selected for full text screening. Finally, 5 citations were included in this review, with a total of 644 patients, mean age 52.16 years. Four studies targeted breast cancer patients and 1 focused on prostate cancer patients. Four studies referred to apps that assessed QoL. Only 1 among the 5 analyzed apps was available from the official app store. In 3 studies, an app-related intervention was carried out, and 2 of them reported an improvement on QoL. The lengths of the app-related interventions varied from 4 to 12 weeks. Because 2 of the studies only tracked use of the app, no effect on QoL or well-being was found. Conclusions: Despite the existence of hundreds of studies involving cancer-focused mobile phone apps, there is a lack of rigorous trials regarding the QoL and/or well-being assessment in breast and/or prostate cancer patients. A strong and collective effort should be made by all health care providers to determine those cancer-focused apps that effectively represent useful, accurate, and reliable tools for cancer patients’ disease management.European Union's Horizon 2020 No 72201