Beyond the trial: A systematic review of real-world uptake and engagement with digital self-help interventions for depression, low mood, or anxiety

Background: Digital self-help interventions (including online or computerized programs and apps) for common mental health issues have been shown to be appealing, engaging, and efficacious in randomized controlled trials. They show potential for improving access to therapy and improving population mental health. However, their use in the real world, that is, as implemented (disseminated) outside of research settings, may differ from that reported in trials, and implementation data are seldom reported. Objective: We aimed to review peer-reviewed articles reporting user uptake and/or ongoing use, retention, or completion data (hereafter ‘usage data’ or, for brevity, ‘engagement’) from implemented pure self-help (unguided) digital interventions for depression, anxiety, or the enhancement of mood. Methods: We conducted a systematic search of the Scopus, Embase, MEDLINE, and PsychINFO databases for studies reporting user uptake and/or usage data from implemented digital self-help interventions for the treatment or prevention of depression or anxiety, or the enhancement of mood, from 2002 to 2017. Additionally, we screened the reference lists of included articles, citations of these articles, and the titles of articles published in Internet Interventions, Journal of Medical Internet Research (JMIR), and JMIR Mental Health since their inception. We extracted data indicating the number of registrations or downloads and usage of interventions. Results: After the removal of duplicates, 970 papers were identified, of which ten met the inclusion criteria. Hand-searching identified one additional article. The included articles reported on seven publically available interventions. There was little consistency in the measures reported. The number of registrants or downloads ranged widely, from eight to over 40,000 per month. From 21% to 88% of users engaged in at least minimal use (e.g. used the intervention at least once or completed one module or assessment), while 7–42% engaged in moderate use (completing between 40% and 60% of modular fixed-length programs or continuing to use apps after four weeks). Indications of completion or sustained use (completion of all modules or the last assessment or continuing to use apps after six weeks or more) varied from 0.5% to 28.6%. Conclusions: Available data suggest that uptake and engagement vary widely among the handful of implemented digital self-help apps and programs which have reported this, and that usage may vary from that reported in trials. Implementation data should be routinely gathered and reported to facilitate improved uptake and engagement, arguably among the major challenges in digital health

Translated points and Rabinowitz Floer homology

We prove that if a contact manifold admits an exact filling then every local contactomorphism isotopic to the identity admits a translated point in the interior of its support, in the sense of Sandon [San11b]. In addition we prove that if the Rabinowitz Floer homology of the filling is non-zero then every contactomorphism isotopic to the identity admits a translated point, and if the Rabinowitz Floer homology of the filling is infinite dimensional then every contactmorphism isotopic to the identity has either infinitely many translated points, or a translated point on a closed leaf. Moreover if the contact manifold has dimension greater than or equal to 3, the latter option generically doesn't happen. Finally, we prove that a generic contactomorphism on $\mathbb{R}^{2n+1}$ has infinitely many geometrically distinct iterated translated points all of which lie in the interior of its support.Comment: 13 pages, v2: numerous corrections, results unchange

Skylab imagery: Application to reservoir management in New England

The author has identified the following significant results. S190B imagery is superior to the LANDSAT imagery for land use mapping and is as useful for level 1 and 2 land use mapping as the RB-57/RC8 high altitude imagery. Detailed land use mapping at levels 3 and finer from satellite imagery requires better resolution. For evaluating factors that are required to determine volume runoff potentials in a watershed, the S190B imagery was found to be as useful as the RB-57/RC8 high altitude aircraft imagery

Effect of Supplementing Grass Silage with Incremental Levels of Water Soluble Carbohydrate on in Vitro Rumen Microbial Growth and N Use Efficiency

The efficiency of utilisation of N for milk production in dairy cows is often less than 25% and a shortfall in readily available carbohydrate to provide substrate for microbial growth is often cited as a potential problem. Grasses bred for their high water soluble carbohydrate (WSC) content have potential to address this issue but there is limited information on the level of sugar required to optimise rumen microbial growth efficiency. The objective of this experiment was to examine the effect of different concentrations of WSC on the efficiency of use of grass silage N under in vitro conditions

Development and evaluation of an intervention to improve further education students' understanding of higher education assessment criteria: three studies

Three studies about helping Further Education students prepare for study at universityThis paper reports three studies about preparing Further Education (FE) students for the transition to Higher Education (HE) by improving their understanding of HE assessment criteria. In study 1, students and tutors in both FE and HE were interviewed for a qualitative analysis of their understandings and expectations about assessment criteria. In study 2, students in FE and HE completed questionnaires measuring self-rated understanding and ability about assessment criteria, and beliefs about essay writing. Studies 1 and 2 both showed that FE students were more confident than HE students about their understanding and ability in relation to assessment criteria, but FE students’ understandings suggested more surface approaches to learning and more naïve epistemological beliefs. In study 3, a workshop intervention to improve FE students’ understandings of HE assessment criteria was evaluated in a comparative longitudinal trial. The intervention reduced FE students’ self-rated understanding and ability, and promoted more sophisticated beliefs about essay writing, by comparison with students who received standard tuition. We concluded that interventions to develop more realistic understandings of what is required in academic writing could be used to prepare FE students more effectively for the transition to HE

Game On? Smoking Cessation Through the Gamification of mHealth: A Longitudinal Qualitative Study

BACKGROUND: Finding ways to increase and sustain engagement with mHealth interventions has become a challenge during application development. While gamification shows promise and has proven effective in many fields, critical questions remain concerning how to use gamification to modify health behavior. OBJECTIVE: The objective of this study is to investigate how the gamification of mHealth interventions leads to a change in health behavior, specifically with respect to smoking cessation. METHODS: We conducted a qualitative longitudinal study using a sample of 16 smokers divided into 2 cohorts (one used a gamified intervention and the other used a nongamified intervention). Each participant underwent 4 semistructured interviews over a period of 5 weeks. Semistructured interviews were also conducted with 4 experts in gamification, mHealth, and smoking cessation. Interviews were transcribed verbatim and thematic analysis undertaken. RESULTS: Results indicated perceived behavioral control and intrinsic motivation acted as positive drivers to game engagement and consequently positive health behavior. Importantly, external social influences exerted a negative effect. We identified 3 critical factors, whose presence was necessary for game engagement: purpose (explicit purpose known by the user), user alignment (congruency of game and user objectives), and functional utility (a well-designed game). We summarize these findings in a framework to guide the future development of gamified mHealth interventions. CONCLUSIONS: Gamification holds the potential for a low-cost, highly effective mHealth solution that may replace or supplement the behavioral support component found in current smoking cessation programs. The framework reported here has been built on evidence specific to smoking cessation, however it can be adapted to health interventions in other disease categories. Future research is required to evaluate the generalizability and effectiveness of the framework, directly against current behavioral support therapy interventions in smoking cessation and beyond