Empowerment or Engagement? Digital Health Technologies for Mental Healthcare

We argue that while digital health technologies (e.g. artificial intelligence, smartphones, and virtual reality) present significant opportunities for improving the delivery of healthcare, key concepts that are used to evaluate and understand their impact can obscure significant ethical issues related to patient engagement and experience. Specifically, we focus on the concept of empowerment and ask whether it is adequate for addressing some significant ethical concerns that relate to digital health technologies for mental healthcare. We frame these concerns using five key ethical principles for AI ethics (i.e. autonomy, beneficence, non-maleficence, justice, and explicability), which have their roots in the bioethical literature, in order to critically evaluate the role that digital health technologies will have in the future of digital healthcare

Smartphone chronic gaming consumption and positive coping practice

Purpose: Chronic consumption practice has been greatly accelerated by mobile, interactive and smartphone gaming technology devices. This study explores how chronic consumption of smartphone gaming produces positive coping practice. Design/methodology/approach: Underpinned by cognitive framing theory, empirical insights from eleven focus groups (n=62) reveal how smartphone gaming enhances positive coping amongst gamers and non-gamers. Findings: The findings reveal how the chronic consumption of games allows technology to act with privileged agency that resolves tensions between individuals and collectives. Consumption narratives of smartphone games, even when play is limited, lead to the identification of three cognitive frames through which positive coping processes operate: (a) the market generated frame, (b) the social being frame, and (c) the citizen frame. Research limitations/implications: This paper adds to previous research by providing an understanding of positive coping practice in the smartphone chronic gaming consumption. Originality/value: In smartphone chronic gaming consumption, cognitive frames enable positive coping by fostering appraisal capacities in which individuals confront, hegemony, culture and alterity-morality concerns

“Smartphone apps are cool, but do they help me?”: A qualitative interview study of adolescents’ perspectives on using smartphone interventions to manage nonsuicidal self-injury

Nonsuicidal self-injury (NSSI) is a major mental health problem associated with negative psychosocial outcomes and it most often starts in early adolescence. Despite this, adolescents are rarely involved in informing the development of interventions designed to address their mental health problems. This study aimed to (1) assess adolescents’ needs and preferences about future interventions that are delivered through smartphones and (2) develop a framework with implications for designing engaging digital mental health interventions. Fifteen adolescent girls, aged 12– 18 years, who met diagnostic criteria for a current NSSI disorder and were in contact with mental health services, participated in semi-structured interviews. Following a reflexive thematic analysis approach, this study identified two main themes: (1) Experiences of NSSI (depicts the needs of young people related to their everyday experiences of managing NSSI) and (2) App in Context (por-trays preferences of young people about smartphone interventions and reflects adolescents’ views on how technology itself can improve or hinder engaging with these interventions). Adolescent patients expressed interest in using smartphone mental health interventions if they recognize them as helpful, relevant for their life situation and easy to use. The developed framework suggests that digital mental health interventions are embedded in three contexts (i.e., person using the interven-tion, mental health condition, and technology-related factors) which together need to inform the development of engaging digital resources. To achieve this, the cooperation among people with lived experience, mental health experts, and human computer interaction professionals is vital

Awakening The Potential of Positive Computing: A Transversal, Heliotropic Design Paradigm for Human Flourishing

Positive Computing literature does not consider the complex implications stemming from the evidence of computing technologies’ harmful effects. Moreover, present approaches to integrating well-being science into the design of interactive systems are built on deficit-oriented models. In response, a transversal, social constructionist paradigm of Positive Computing sensitive to the social complex and views technology as a part ofcivilization as a living, human construction is explored as a means of advancing the Positive Computing domain. The work argues the well-being of civilization needs to be routinely re-secured through the development of a metacognitive, affirmative competency that recognizessocial systems as capable of creating their own realities. To effectuate the change, adoption of an integral awareness of the socio-technical complex and a new, positively oriented model of design for interactive computing technologies are proposed

Invisible Influence: Artificial Intelligence and the Ethics of Adaptive Choice Architectures

For several years, scholars have (for good reason) been largely preoccupied with worries about the use of artificial intelligence and machine learning (AI/ML) tools to make decisions about us. Only recently has significant attention turned to a potentially more alarming problem: the use of AI/ML to influence our decision-making. The contexts in which we make decisions—what behavioral economists call our choice architectures—are increasingly technologically-laden. Which is to say: algorithms increasingly determine, in a wide variety of contexts, both the sets of options we choose from and the way those options are framed. Moreover, artificial intelligence and machine learning (AI/ML) makes it possible for those options and their framings—the choice architectures—to be tailored to the individual chooser. They are constructed based on information collected about our individual preferences, interests, aspirations, and vulnerabilities, with the goal of influencing our decisions. At the same time, because we are habituated to these technologies we pay them little notice. They are, as philosophers of technology put it, transparent to us—effectively invisible. I argue that this invisible layer of technological mediation, which structures and influences our decision-making, renders us deeply susceptible to manipulation. Absent a guarantee that these technologies are not being used to manipulate and exploit, individuals will have little reason to trust them

Behavior change techniques in mobile apps targeting self-harm in young people: a systematic review

Despite the high prevalence of self-harm among young people, as well as their extensive use of mobile apps for seeking support with their mental healthcare, it is unclear whether the design of mobile apps aimed at targeting self-harm is underpinned by behavior change techniques (BCTs). To systematically analyze and identify (a) what BCTs and (b) what theories are present in self-harm apps for young people in an attempt to understand their active components. Systematic searches in Apple store, followed by thorough screening, were conducted to identify free mobile apps targeting self-harm in young people. Five apps met the inclusion criteria and were used by trained researchers, who coded identified features against the BCT Taxonomy V1. Despite the majority of apps being underpinned by principles of Dialectical Behavior Therapy (DBT), no other information is available about specific theories underpinning these apps. Nineteen of the 93 BCTs were identified across the five apps. The most frequently used BCT was "Distraction"(54.2%), offering ideas for activities to distract users from self-harming. Other techniques that were used often were "Social Support (unspecified)"(27.0%) and "Behavior Substitution"(10.6%). This study provides the first analysis of BCTs present in mental health apps which are designed to target the reduction of self-harm in young people. Future research is needed to evaluate the effectiveness of the apps, as well as assess the effectiveness of the BCTs present

A randomized 3-month, parallel-group, controlled trial of CALMA m-health app as an adjunct to therapy to reduce suicidal and non-suicidal self-injurious behaviors in adolescents: study protocol

Background: Suicidal and non-suicidal self-injurious behaviors are among the leading causes of death and injury in adolescents and youth worldwide. Mobile app development could help people at risk and provide resources to deliver evidence-based interventions. There is no specific application for adolescents and young people available in Spanish. Our group developed CALMA, the first interactive mobile application with the user in Spanish, which provides tools based on Dialectical Behavioral Therapy to manage a crisis of suicidal or non-suicidal self-directed violence with the aim of preventing suicide in adolescents and youth. Methods: To test the effectiveness, safety and level of engagement of the CALMA app in people aged 10 to 19 who are treated in mental health services of two public hospitals, we will conduct a parallel-group, two-arm randomized controlled trial. Participants will be assessed face-to-face and via video call at four timepoints: day-0 (baseline), day-30, day-60, and day-90. A total of 29 participants per group will be included. Change in the frequency of suicidal and non-suicidal self-injurious behaviors will be compared between groups, as well as the level of emotional dysregulation, level of app engagement and time of psychiatric admission during the follow-up period. Discussion: This study is particularly relevant to young people given their widespread use of mobile technology, while there are currently no available smartphone app-based self-guided psychological strategies in Spanish that attempt to reduce suicidal behavior in adolescents who are assisted in the public health sector from low and middle-income countries in Latin America.Fil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Chiapella, Luciana Carla. Universidad Nacional de Rosario. Facultad de Ciencias Bioquímicas y Farmacéuticas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario; ArgentinaFil: Olivera Fedi, Ramiro. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Papavero, Eliana Belen. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Lavoie, Kim L.. Université du Québec a Montreal; CanadáFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Social Media Use and Access to Digital Technology in US Young Adults in 2016.

BACKGROUND: In 2015, 90% of US young adults with Internet access used social media. Digital and social media are highly prevalent modalities through which young adults explore identity formation, and by extension, learn and transmit norms about health and risk behaviors during this developmental life stage. OBJECTIVE: The purpose of this study was to provide updated estimates of social media use from 2014 to 2016 and correlates of social media use and access to digital technology in data collected from a national sample of US young adults in 2016. METHODS: Young adult participants aged 18-24 years in Wave 7 (October 2014, N=1259) and Wave 9 (February 2016, N=989) of the Truth Initiative Young Adult Cohort Study were asked about use frequency for 11 social media sites and access to digital devices, in addition to sociodemographic characteristics. Regular use was defined as using a given social media site at least weekly. Weighted analyses estimated the prevalence of use of each social media site, overlap between regular use of specific sites, and correlates of using a greater number of social media sites regularly. Bivariate analyses identified sociodemographic correlates of access to specific digital devices. RESULTS: In 2014, 89.42% (weighted n, 1126/1298) of young adults reported regular use of at least one social media site. This increased to 97.5% (weighted n, 965/989) of young adults in 2016. Among regular users of social media sites in 2016, the top five sites were Tumblr (85.5%), Vine (84.7%), Snapchat (81.7%), Instagram (80.7%), and LinkedIn (78.9%). Respondents reported regularly using an average of 7.6 social media sites, with 85% using 6 or more sites regularly. Overall, 87% of young adults reported access or use of a smartphone with Internet access, 74% a desktop or laptop computer with Internet access, 41% a tablet with Internet access, 29% a smart TV or video game console with Internet access, 11% a cell phone without Internet access, and 3% none of these. Access to all digital devices with Internet was lower in those reporting a lower subjective financial situation; there were also significant differences in access to specific digital devices with Internet by race, ethnicity, and education. CONCLUSIONS: The high mean number of social media sites used regularly and the substantial overlap in use of multiple social media sites reflect the rapidly changing social media environment. Mobile devices are a primary channel for social media, and our study highlights disparities in access to digital technologies with Internet access among US young adults by race/ethnicity, education, and subjective financial status. Findings from this study may guide the development and implementation of future health interventions for young adults delivered via the Internet or social media sites

Syrian Refugees and the Digital Passage to Europe: Smartphone Infrastructures and Affordances

This research examines the role of smartphones in refugees’ journeys. It traces the risks and possibilities afforded by smartphones for facilitating information, communication, and migration flows in the digital passage to Europe. For the Syrian and Iraqi refugee respondents in this France-based qualitative study, smartphones are lifelines, as important as water and food. They afford the planning, navigation, and documentation of journeys, enabling regular contact with family, friends, smugglers, and those who help them. However, refugees are simultaneously exposed to new forms of exploitation and surveillance with smartphones as migrations are financialised by smugglers and criminalized by European policies, and the digital passage is dependent on a contingent range of sociotechnical and material assemblages. Through an infrastructural lens, we capture the dialectical dynamics of opportunity and vulnerability, and the forms of resilience and solidarity, that arise as forced migration and digital connectivity coincide

Defining and Identifying Attention Capture Deceptive Designs in Digital Interfaces

Many tech companies exploit psychological vulnerabilities to design digital interfaces that maximize the frequency and duration of user visits. Consequently, users often report feeling dissatisfied with time spent on such services. Prior work has developed typologies of damaging design patterns (or dark patterns) that contribute to financial and privacy harms, which has helped designers to resist these patterns and policymakers to regulate them. However, we are missing a collection of similar problematic patterns that lead to attentional harms. To close this gap, we conducted a systematic literature review for what we call 'attention capture damaging patterns' (ACDPs). We analyzed 43 papers to identify their characteristics, the psychological vulnerabilities they exploit, and their impact on digital wellbeing. We propose a definition of ACDPs and identify eleven common types, from Time Fog to Infinite Scroll. Our typology offers technologists and policymakers a common reference to advocate, design, and regulate against attentional harms