Design of a game-based training environment to enhance mental health care professionals' skills in using e-mental health:Multiple methods user requirements analysis

Background: A major factor hampering the adoption of technology in mental health care is a lack of knowledge and skills. Serious gaming offers a potentially effective strategy to enhance the skills needed through experiencing and learning-by-doing in a playful way. However, serious gaming solutions are not widely available for mental health care. Therefore, the development of a game-based training environment in mental health care was pursued in a design project. The first step in such a design project is to identify user requirements that should be met. Objective: This study aims to deliver user requirements that inform the design of a game-based training environment for mental health care professionals. This environment aims to support mental health care professionals’ knowledge and skill enhancement regarding the use of e–mental health (eMH); for example, video calling, mobile apps, web-based treatment modules, and techniques such as virtual or augmented reality. Methods: We used an exploratory multiple methods design consisting of a web-based questionnaire, co-design sessions, and interviews. To ensure a good representation of the target user group, professionals from various disciplines within mental health care were included in the research. The multiple methods design facilitates a broad view of user needs and in-depth knowledge of specific design requirements. We describe the protocol for this research project in a protocol paper published in the JMIR Research Protocols in February 2021. Results: The user requirements analysis revealed three types of users for the envisioned game-based training environment: mental health care professionals who want to learn about the basic possibilities of eMH, mental health care professionals who want to develop their eMH skills to the next level, and mental health care professionals who want to experiment with new technologies. This reflects the diversity of needs that were identified, as well as the need to develop a diversity of suitable scenarios in the environment. User requirements analysis shows that the focus of a training environment should be on increasing knowledge about the possibilities of eMH, focusing on experiencing the benefits in particular situations, and building confidence in using eMH in a therapeutic setting. This requires careful consideration of the suitable game characteristics. Conclusions: Improvement of mental health care professionals’ skills in eMH requires an environment that is user driven and flexible, and simultaneously incorporates contextual factors that are relevant for its implementation in practice. This user requirements analysis contributes to the understanding of the issues that should be considered in the development of a game-based training environment. This shows that there are multiple and diverse learning needs among mental health care professionals. Various client populations, services, and situations demand various options for training. International Registered Report Identifier (IRRID): RR2-102196/1881

Assessing professionals' adoption readiness for eMental health:Development and validation of the eMental health adoption readiness scale

BACKGROUND: The last few decades have witnessed significant advances in the development of digital tools and applications for mental health care. Despite growing evidence for their effectiveness, acceptance and use of these tools in clinical practice remain low. Hence, a validated and easy-to-use instrument for assessing professionals’ readiness to adopt eMental health (EMH) is necessary to gain further insights into the process of EMH adoption and facilitate future research on this topic. OBJECTIVE: The aim of this study is to develop and validate an instrument for assessing mental health care professionals’ readiness to adopt EMH. METHODS: Item generation was guided by literature and inputs from mental health care professionals and experts in survey development. Exploratory factor analyses were conducted on an initial set of 29 items completed by a sample of mental health care professionals (N=432); thereafter, the scale was reduced to 15 items in an iterative process. The factor structure thus obtained was subsequently tested using a confirmatory factor analysis with a second sample of mental health care professionals (N=363). The internal consistency, convergent validity, and predictive validity of the eMental Health Adoption Readiness (eMHAR) Scale were assessed. RESULTS: Exploratory factor analysis resulted in a 3-factor solution with 15 items. The factors were analyzed and labeled as perceived benefits and applicability of EMH, EMH proactive innovation, and EMH self-efficacy. These factors were confirmed through a confirmatory factor analysis. The total scale and subscales showed a good internal consistency (Cronbach α=.73-.88) along with acceptable convergent and predictive relationships with related constructs. CONCLUSIONS: The constructed eMHAR Scale showed a conceptually interpretable 3-factor structure having satisfactory characteristics and relationships with relevant concepts. Its ease of use allows for quick acquisition of data that can contribute to understanding and facilitating the process of adoption of EMH by clinical professionals

The Influence of Personal Health Data on the Health Coaching Process

Tracking health data, for example, through wearable devices or health apps, is increasingly commonplace. Consequently, health coaches (e.g., personal trainers, dieticians) are facing growing numbers of clients who bring their data to the clinic. These data potentially add value to the coaching process, for example, by showing more objective and specific information on clients' behaviors. However, in practice, it turns out to be hard to effectively utilize health data in a coaching setting, and it is not yet fully understood how data affect the coaching process and the coach-client communication. We organized a workshop (12 coaches, 3 clients) and a field study (5 coaches, 6 clients), where we observed coach-client interactions enriched with data. By including both familiar and unfamiliar coach-client pairs, as well as alternating the timing of the data presented (i.e., at the beginning, or halfway through the session), we acquired a variety of data-driven coaching interactions and analyzed this using a mixture of qualitative and quantitative methods. Our results show that data are not “plug-and-play.” There is an extensive process of interpreting and contextualizing data, in which the client has a key role, which is essential to gain relevant and actionable insights from the data useful to the coaching process. We also observed that data affect the coach-client communication on both content and relationship levels. We will reflect on these insights in terms of design recommendations for wearable tracking devices and e-health technology to effectively support health coaches and their interactions with their clients

Towards the diversification of drivers and barriers for the adoption of eMental health by professionals: a conceptual model

Introduction: The Internet and mediated communication technologies offer major opportunities in supporting mental healthcare, and evidence for the effectiveness of eMental health is growing. However, their acceptance and use in clinical practice remains low. Material & methods: The current study deployed a qualitative descriptive approach to gain structured insight into the experienced drivers and barriers to adoption of eMental health from the perspective of clinical psychologists. Results: Multiple drivers and barriers emerged from the analysis of the data, several of which are new to the literature. Importantly, particular drivers and barriers are experienced differently by practitioners depending on the extent to which they have adopted online treatment. Based on these findings, we constructed the Levels of Adoption of eMental Health (LAMH) model, which distinguishes several categories of adoption of eMental health, and characterizes experienced drivers and barriers as a function of them. The LAMH model was then supported through a communicative validation. Conclusion: The LAMH model provides a more structured understanding of the process of adopting eMental health, thereby facilitating future research on this topic, and informs targeted recommendations with respect to technology, training and clinical practice that take into account the individual level of adoption

Assessing professionals' adoption readiness for emental health: Development and validation of the emental health adoption readiness scale

Background: Over the last decades, significant advances have been made in the development of digital tools and applications for mental healthcare. Yet, despite growing evidence for their effectiveness, their acceptance and use in clinical practice remain low. To gain further insights in the process of eMental Health adoption and to facilitate future research on this topic, a validated and easy-to-use instrument to assess professionals' readiness to adopt eMental Health is necessary. Objective: The aim of this study was to develop and validate an instrument for assessing mental healthcare professionals' adoption readiness for eMental Health. Methods: Item generation was guided by literature and input from mental healthcare professionals and experts in survey development. Exploratory factor analyses were conducted on an initial set of 29 items completed by a sample of mental healthcare professionals (N = 432), after which the scale was reduced to 15 items in an iterative process. The factor structure thus obtained was subsequently tested with a confirmatory factor analysis with a second sample of mental healthcare professionals (N = 363). Internal consistency, convergent validity and predictive validity of the eMHAR Scale were assessed. Results: Exploratory factor analyses resulted in a three-factor solution with 15 items. The factors were analyzed and labeled as ‘perceived benefits and applicability of EMH’, ‘EMH proactive innovation’, and ‘EMH self-efficacy’. These factors were confirmed through a confirmatory factor analysis. The total scale and subscales showed good internal consistency (Cronbach’s alpha = 0.73-0.88) and acceptable convergent and predictive relations to related constructs. Conclusions: The constructed eMHAR Scale showed a conceptually interpretable three-factor structure with satisfactory characteristics and relationships with relevant concepts. Its ease of use allows for a quick acquisition of data that can contribute to understanding and facilitating the process of adoption of eMental Health by clinical professionals

Enhancing empathic interactions in mental health care: opportunities offered through social interaction technologies

Therapeutic rapport and empathy are essential parts of the relationship between mental health care professionals and their clients and are considered key elements of good therapeutic outcome. There are various social interaction technologies that have proven to be beneficial to current psychotherapeutic practice. Despite their proven efficacy, the adoption of these technologies among therapists is still relatively low. A prominent reason for this is the perception that mediated communication does not allow for satisfying empathic interactions. However, new technological developments offer opportunities that could help overcome this barrier and possibly even enhance the empathic interaction. The current paper explores these novel technologies in a systematic way by mapping them to the three components of empathy (cognition, affect, behavior). By identifying these opportunities, we hope to encourage a new way of thinking about technology, emphasizing its potential added value to the quality of psychological treatment, and eventually aiming to broaden the array of available treatment possibilities for mental healthcare professionals

Sharing Biosignals: An Analysis of the Experiential and Communication Properties of Interpersonal Psychophysiology

Biosensing technologies have advanced to a level where measurements of our physiology have become easily accessible, and new areas of application are being explored, including interpersonal communication via biosignals. To date, it is largely unknown what the communication characteristics of biosignal sharing are and how they influence experiences of biosignal-mediated interactions. By conceptualizing biosignal sharing as a new communication medium, we try to benefit from earlier theories and models that help describe and understand the communication properties that are inherently part of biosignal sharing, but have not previously been examined in this way. In this paper, we review the published literature on biosignal sharing and analyze the current state of the art using two complementary methods of analysis. First, we extend an existing framework of relevant communication dimensions and apply this to examine the characteristics of biosignal sharing systems. Second, we perform a thematic analysis on user experiences related to biosignal sharing available from literature. Then, we combine these findings and link the communication characteristics to the experiences of biosignal sharing. We discuss our findings, elucidating the way in which biosignal sharing affects the interpersonal communication process. Based on these insights, we provide several considerations for future research and design

Empathic interactions in online treatment: experiences of mental healthcare practitioners

Studies on practitioners' perceptions of eMental Health repeatedly report experienced difficulties in establishing empathic interactions when communicating with their clients online – a fact that plays an important role in the adoption, or lack thereof, of technology-mediated treatments. Especially now, in times when social distancing and lockdown measures are effectuated globally to combat the COVID-19 pandemic, the need for high-quality online formats of mental health care has become more urgent than ever. To increase our understanding of the process of achieving empathic interactions in technology-mediated communication, the current paper presents an online survey study using open questions on practitioners' experiences of establishing empathy in online therapeutic interactions (n = 363). Responses were analyzed using thematic analysis. From the derived themes, a conceptual model was built showing several properties of online communication that influence empathy and ways in which these properties affect the therapeutic interaction on emotional, conversational, and relational levels. Additionally, our findings highlight the behavioral strategies practitioners employ to find workarounds to manage these effects and attempt to (re)connect with their clients. Our findings thus provide experience-based insights into the process of building empathy in online treatments – insights that can be used to improve current and future eMental Health technologies, enabling practitioners to reach the desired level of empathic understanding during remote therapeutic interactions

The effect of simulated feedback about psychophysiological synchronization on perceived empathy and connectedness

Social interaction technologies have increasingly become available to psychotherapeutic practice. Despite evidence for their efficacy and other unique benefits, adoption among therapists is still relatively low. A main barrier for therapists is their perception that the ability to empathize and connect with their clients is compromised in technology-mediated interactions. However, the unique affordances of technologies also offer opportunities that could help overcome this barrier and possibly even enhance the empathic interaction. One potential direction is to augment social interaction with feedback derived from psychophysiological measures. A specific interpersonal psychophysiological phenomenon that seems particularly relevant is psychophysiological synchronization, the occurrence of substantial levels of synchrony in human physiology between persons, which has been linked to empathy. The current study investigates the effect of (simulated) feedback about psychophysiological synchronization on perceived empathy and connectedness. Sixty-six participants received simulated feedback, indicating high or low synchronization, while watching an emotionally salient movie simultaneously with a confederate in a separate room. Participants receiving feedback indicating high synchronization reported higher levels of perceived empathy and connectedness compared to the low synchronization feedback group. This study suggests that feedback about physiological synchronization might be used to influence levels of empathy and connectedness in remote interactions, which could potentially be applied to increase empathy between therapists and clients in technology-mediated psychological treatment

The design of a game-based training environment to enhance health care professionals’ skills in using eMental health: study protocol for the user requirements analysis

Background: eMental health (EMH) offers various possibilities for mental healthcare delivery, with many studies demonstrating its clinical efficacy. However, the uptake of EMH technologies by mental healthcare professionals remains low. One of the reasons for this is the lack of knowledge and skills in using these technologies. Skill enhancement by means of serious gaming has shown to be effective in other areas already, but has not yet been applied to developing EMH skills of mental healthcare professionals. Objective: The objective of this paper is to describe the study protocol for the user requirements analysis for the design of a game-based training environment for mental healthcare professionals to enhance their skills in EMH. Methods: The user requirements will be formulated using three complementary outputs: personas (lively descriptions of potential users), scenarios (situations that require EMH skills), and prerequisites (required technical and organizational conditions). Data is collected by a questionnaire, co-design sessions, and interviews. The questionnaire is used to determine mental healthcare professionals’ characteristics, attitudes and skill levels regarding EMH and is distributed among mental healthcare professionals in the Netherlands. This leads to a number of recognizable (sub) user groups and forms the basis for the personas. Co-design sessions with mental healthcare professionals are used to further specify the personas and to identify different user scenarios for the game-based training environment. Interviews with mental healthcare professionals will help determine the preferences of mental healthcare professionals regarding training in EMH, as well as the technical and organizational conditions required for the prospective game-based training environment to be used in practice. This combination of requirements elicitation methods allows for a good representation of the target population in terms of both a broad view of user needs (through the large N questionnaire) as well as an in-depth understanding of specific design requirements (through interviews and co-design). Results: The questionnaire has been distributed and has been filled in by 432 respondents. Two co-design sessions with mental healthcare professionals and 17 interviews have also taken place. The data is currently being analyzed, which is expected to be finalized in the first half of 2020. Conclusions: To develop an environment that can effectively support professionals’ EMH skill development, it is important to offer training possibilities that address the specific needs of mental healthcare professionals. The approach as described in this protocol incorporates the elements that enable the design of a playful training environment that is user-driven and flexible, at the same time considering the technical and organizational prerequisites that influence its implementation in practice