Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review

Background: The public health impact of health and well-being digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently largely dependent on popularity indicators (eg, ranking and user ratings on app stores), which may not correspond with effectiveness, and rapid disengagement is common. Therefore, there is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools. Objective: This review aimed to understand what is known about influences on the uptake of and engagement with health and well-being smartphone apps among adults. Methods: We conducted a systematic review of quantitative, qualitative, and mixed methods studies. Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior. Studies identified through a systematic search in Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Scopus, Cochrane library databases, DataBase systems and Logic Programming (DBLP), and Association for Computing Machinery (ACM) Digital library were screened, with a proportion screened independently by 2 authors. Data synthesis and interpretation were undertaken using a deductive iterative process. External validity checking was undertaken by an independent researcher. A narrative synthesis of the findings was structured around the components of the capability, opportunity, motivation, behavior change model and the theoretical domains framework (TDF). Results: Of the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E). Conclusions: Across a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps. Our recommendations may help app developers, health app portal developers, and policy makers in the optimization of health and well-being apps

People, Land, Arts, Culture and Engagement: Taking Stock of the Place Initiative

This report serves as a point of entry into creative placemaking as defined and supported by the Tucson Pima Arts Council's PLACE Initiative. To assess how and to what degree the PLACE projects were helping to transform communities, TPAC was asked by the Kresge Foundation to undertake a comprehensive evaluation. This involved discussion with stakeholders about support mechanisms, professional development, investment, and impact of the PLACE Initiative in Tucson, Arizona, and the Southwest regionally and the gathering of qualitative and quantitative data to develop indicators and method for evaluating the social impact of the arts in TPAC's grantmaking. The report documents one year of observations and research by the PLACE research team, outside researchers and reviewers, local and regional working groups, TPAC staff, and TPAC constituency. It considers data from the first four years of PLACE Initiative funding, including learning exchanges, focus groups, individual interviews, grantmaking, and all reporting. It is also informed by evaluation and assessment that occurred in the development of the PLACE Initiative, in particular, Maribel Alvarez's Two-Way Mirror: Ethnography as a Way to Assess Civic Impact of Arts-Based Engagement in Tucson, Arizona (2009), and Mark Stern and Susan Seifert's Documenting Civic Engagement: A Plan for the Tucson Pima Arts Council (2009). Both of these publications were supported by Animating Democracy, a program of Americans for the Arts, that promotes arts and culture as potent contributors to community, civic, and social change. Both publications describe how TPAC approaches evaluation strategies associated with social impact of the arts in Tucson and Pima County. This report outlines the local context and historical antecedents of the PLACE Initiative in the region with an emphasis on the concept of "belonging" as a primary characteristic of PLACE projects and policy. It describes PLACE projects as well as the role of TPAC in creating and facilitating the Initiative. Based on the collective understanding of the research team, impacts of the PLACE Initiative are organized into three main realms -- institutions, artists, and communities. These realms are further addressed in case studies from select grantees, whose narratives offer rich, detailed perspectives about PLACE projects in context, with all their successes, rewards, and challenges for artists, communities, and institutions. Lastly, the report offers preliminary research findings on PLACE by TPAC in collaboration with Dr. James Roebuck, codirector of the University of Arizona's ERAD (Evaluation Research and Development) Program

Approaching Trans Healthcare Competency: The Implementation of Trans Health Education for Medical Providers in Appalachia

Barriers to competent and safe healthcare disproportionately impact people who are marginalized because of their race, ethnicity, gender, or socioeconomic status. It is well documented that transgender patients in particular experience barriers to both accessing care and receiving high quality, non-discriminatory care (Hatzenbuehler & Pachankis, 2016; James et al., 2016; Rahman et al., 2019; Safer et al., 2016). This lack of access to culturally competent healthcare services contributes to health disparities that disproportionately impact the trans community. Literature on barriers to competent care for trans patients indicates that providers experience discomfort related to their ability to provide competent care (Safer et al., 2016). Many providers endorse a median of only five hours of trans healthcare training across their entire medical school curriculum (Hughto et al., 2015), and in some cases, as little as 45 minutes per year (Sawning et al., 2017). Primary care clinics should be the place in which general health and wellbeing are addressed for trans patients, as has been true for cisgender people. Primary care providers should be competent in assessing eligibility for Hormone Replacement Therapy (HRT) and surgery (Wylie et al., 2016), as well as providing necessary preventative care. Thus, this makes primary care the ideal setting for the proposed medical education implementation project. The current study aimed to develop and implement a training program for medical residents in primary care in rural South Central Appalachia. A six-stage development and implementation study is described. The intervention was evaluated for pedagogical outcomes including sustainability for future use, usefulness to residents, and accessibility. Evaluation of effectiveness included analyses of changes in providers’ self-reported competency, awareness of discriminatory experiences, and attitudes towards treating trans patients. There were no significant differences in pre-post competency scores (r=22, M=33.29[SD=5.96]; r=31, M=37.33[SD=1.02], SD=8.00) or in pre-post attitudes scores (r=15, M=32.76[SE=0.8], SD=4.69; r=13, M=34.7273[SE=1.00], SD=4.692). Accessibility and sustainability were measured qualitatively and included data such as resident attendance and ease of use of material for future behavioral health provider trainers. These outcomes were found to be satisfactory based on stakeholder feedback. Usefulness included three data points (satisfaction, helpfulness, value of training)

Bisexual Women's Mental Health Research: A Community-based, Social Justice Approach

The goals of this paper were to review the public health literature on bisexual women’s mental health, discuss the strengths and limitations of the research and propose a social justice framework for a future research agenda. The social justice framework includes Community-Based Participatory Research and the use of an intersectional approach. The literature has found bisexual women to have higher rates of depression, anxiety and suicidality than heterosexual and lesbian women, indicating the public health significance of this topic. Reported protective factors of mental health for bisexual women were social support and connectedness to the lesbian gay bisexual transgender community. Risk factors were discrimination, lack of community and social support, poverty, substance use, self-harm and eating Disorders. Limitations of the research include but are not limited to inconsistent categorization of sex category and gender expression, lack of population-based random samples, and lack of longitudinal data. Current research falsely approaches bisexual women as an unstratified and monolithic community, defaulting to unmarked privileged categories. The small body of research on this topic is lacking but warrants further investigation through longitudinal and qualitative community-driven studies

Bye Bye Binary: Exploring Non-Binary Youths\u27 Experiences of Mental Health, Discrimination, and Community Belongingness

In recent years, there has been an increase in research focusing on the impacts of social exclusion and discrimination on the mental health of transgender populations. Despite this, few studies have focused on the experiences of gender non-conforming, or “non-binary” individuals. This community-based participatory research (CBPR) study (N = 10) used the arts-informed method of body mapping, individual interviews, and group discussions to examine non-binary young peoples’ experiences of discrimination in relation to mental health. Participants consisted young people (ages 16-25) living in Waterloo, Ontario. A visual analysis, thematic analysis, and member-checking session were employed to analyze collected data. In the following thesis document, I present two manuscripts where I share a) a methodological reflection of engaging with qualitative and arts-based approaches, and b) results pertaining to mental health, discrimination, and community belongingness. I describe how I, a non-binary researcher, grappled with my positionality within the research context, theoretical frameworks, and commitments to undertaking research with and for community. Implications for institutional policy, curriculum, and pedagogy within post-secondary institutions are discussed