Comparison of self-administered survey questionnaire responses collected using mobile apps versus other methods

Background: Self-administered survey questionnaires are an important data collection tool in clinical practice, public health research and epidemiology. They are ideal for achieving a wide geographic coverage of the target population, dealing with sensitive topics and are less resource intensive than other data collection methods. These survey questionnaires can be delivered electronically, which can maximise the scalability and speed of data collection while reducing cost. In recent years, the use of apps running on consumer smart devices (i.e., smartphones and tablets) for this purpose has received considerable attention. However, variation in the mode of delivering a survey questionnaire could affect the quality of the responses collected. Objectives: To assess the impact that smartphone and tablet apps as a delivery mode have on the quality of survey questionnaire responses compared to any other alternative delivery mode: paper, laptop computer, tablet computer (manufactured before 2007), short message service (SMS) and plastic objects. Search methods: We searched MEDLINE, EMBASE, PsycINFO, IEEEXplore, Web of Science, CABI: CAB Abstracts, Current Contents Connect, ACM Digital, ERIC, Sociological Abstracts, Health Management Information Consortium, the Campbell Library and CENTRAL. We also searched registers of current and ongoing clinical trials such as ClinicalTrials.gov and the World Health Organization (WHO)International Clinical Trials Registry Platform. We also searched the grey literature in OpenGrey, Mobile Active and ProQuest Dissertation & Theses. Lastly, we searched Google Scholar and the reference lists of included studies and relevant systematic reviews. We performed all searches up to 12 and 13 April 2015. Selection criteria: We included parallel randomised controlled trials (RCTs), crossover trials and paired repeated measures studies that compared the electronic delivery of self-administered survey questionnaires via a smartphone or tablet app with any other delivery mode. We included data obtained from participants completing health-related self-administered survey questionnaire, both validated and non-validated. We also included data offered by both healthy volunteers and by those with any clinical diagnosis. We included studies that reported any of the following outcomes: data equivalence; data accuracy; data completeness; response rates; differences in the time taken to complete a survey questionnaire; differences in respondent’s adherence to the original sampling protocol; and acceptability to respondents of the delivery mode. We included studies that were published in 2007 or after, as devices that became available during this time are compatible with the mobile operating system (OS) framework that focuses on apps. Data collection and analysis: Two review authors independently extracted data from the included studies using a standardised form created for this systematic review in REDCap. They then compared their forms to reach consensus. Through an initial systematic mapping on the included studies, we identified two settings in which survey completion took place: controlled and uncontrolled. These settings differed in terms of (i) the location where surveys were completed, (ii) the frequency and intensity of sampling protocols, and (iii) the level of control over potential confounders (e.g., type of technology, level of help offered to respondents).We conducted a narrative synthesis of the evidence because a meta-analysis was not appropriate due to high levels of clinical and methodological diversity. We reported our findings for each outcome according to the setting in which the studies were conducted. Main results: We included 14 studies (15 records) with a total of 2275 participants; although we included only 2272 participants in the final analyses as there were missing data for three participants from one included study. Regarding data equivalence, in both controlled and uncontrolled settings, the included studies found no significant differences in the mean overall scores between apps and other delivery modes, and that all correlation coefficients exceeded the recommended thresholds for data equivalence. Concerning the time taken to complete a survey questionnaire in a controlled setting, one study found that an app was faster than paper, whereas the other study did not find a significant difference between the two delivery modes. In an uncontrolled setting, one study found that an app was faster than SMS. Data completeness and adherence to sampling protocols were only reported in uncontrolled settings. Regarding the former, an app was found to result in more complete records than paper, and in significantly more data entries than an SMS-based survey questionnaire. Regarding adherence to the sampling protocol, apps may be better than paper but no different from SMS. We identified multiple definitions of acceptability to respondents, with inconclusive results: preference; ease of use; willingness to use a delivery mode; satisfaction; effectiveness of the system informativeness; perceived time taken to complete the survey questionnaire; perceived benefit of a delivery mode; perceived usefulness of a delivery mode; perceived ability to complete a survey questionnaire; maximum length of time that participants would be willing to use a delivery mode; and reactivity to the delivery mode and its successful integration into respondents’ daily routine. Finally, regardless of the study setting, none of the included studies reported data accuracy or response rates. Authors’ conclusions: Our results, based on a narrative synthesis of the evidence, suggest that apps might not affect data equivalence as long as the intended clinical application of the survey questionnaire, its intended frequency of administration and the setting in which it was validated remain unchanged. There were no data on data accuracy or response rates, and findings on the time taken to complete a self-administered survey questionnaire were contradictory. Furthermore, although apps might improve data completeness, there is not enough evidence to assess their impact on adherence to sampling protocols. None of the included studies assessed how elements of user interaction design, survey questionnaire design and intervention design might influence mode effects. Those conducting research in public health and epidemiology should not assume that mode effects relevant to other delivery modes apply to apps running on consumer smart devices. Those conducting methodological research might wish to explore the issues highlighted by this systematic review

Systematic meta-review of supported self-management for asthma: a healthcare perspective

BACKGROUND: Supported self-management has been recommended by asthma guidelines for three decades; improving current suboptimal implementation will require commitment from professionals, patients and healthcare organisations. The Practical Systematic Review of Self-Management Support (PRISMS) meta-review and Reducing Care Utilisation through Self-management Interventions (RECURSIVE) health economic review were commissioned to provide a systematic overview of supported self-management to inform implementation. We sought to investigate if supported asthma self-management reduces use of healthcare resources and improves asthma control; for which target groups it works; and which components and contextual factors contribute to effectiveness. Finally, we investigated the costs to healthcare services of providing supported self-management. METHODS: We undertook a meta-review (systematic overview) of systematic reviews updated with randomised controlled trials (RCTs) published since the review search dates, and health economic meta-analysis of RCTs. Twelve electronic databases were searched in 2012 (updated in 2015; pre-publication update January 2017) for systematic reviews reporting RCTs (and update RCTs) evaluating supported asthma self-management. We assessed the quality of included studies and undertook a meta-analysis and narrative synthesis. RESULTS: A total of 27 systematic reviews (n = 244 RCTs) and 13 update RCTs revealed that supported self-management can reduce hospitalisations, accident and emergency attendances and unscheduled consultations, and improve markers of control and quality of life for people with asthma across a range of cultural, demographic and healthcare settings. Core components are patient education, provision of an action plan and regular professional review. Self-management is most effective when delivered in the context of proactive long-term condition management. The total cost (n = 24 RCTs) of providing self-management support is offset by a reduction in hospitalisations and accident and emergency visits (standard mean difference 0.13, 95% confidence interval -0.09 to 0.34). CONCLUSIONS: Evidence from a total of 270 RCTs confirms that supported self-management for asthma can reduce unscheduled care and improve asthma control, can be delivered effectively for diverse demographic and cultural groups, is applicable in a broad range of clinical settings, and does not significantly increase total healthcare costs. Informed by this comprehensive synthesis of the literature, clinicians, patient-interest groups, policy-makers and providers of healthcare services should prioritise provision of supported self-management for people with asthma as a core component of routine care. SYSTEMATIC REVIEW REGISTRATION: RECURSIVE: PROSPERO CRD42012002694 ; PRISMS: PROSPERO does not register meta-reviews

mHealth for Maternal Mental Health: Everyday Wisdom in Ethical Design

Health and wellbeing applications increasingly raise ethical issues for design. User-centred and participatory design approaches, while grounded in everyday wisdom, cannot be expected to address ethical reflection consistently, as multiple value systems come into play. We explore the potential of phronesis , a concept from Aristotelian virtue ethics, for mHealth design. Phronesis describes wisdom and judgment garnered from prac tical experience of specific situations in context. Applied phronesis contributes everyday wisdom to challenging issues for vulnerable target users. Drawing on research into mHealth technologies for psychological wellbeing, we explore how phronesis can inform ethical design. Using a case study on an app for self- reporting symptoms of depression during pregnancy, we present a framework for incorporating a phronetic approach into design, involving: (a) a wide feedback net to capture phronetic input early in design; (b) observing the order of feedback, which directly affects value priorities in design; (c) ethical pluralism recognising different coexisting value systems; (d) acknowledging subjectivity in the disclosure and recognition of individual researcher and participant values. We offer insights into how a phronetic approach can contribute everyday wisdom to designing mHealth technologies to help designers foster the values that promote human flourishing

Engagement with mental health screening on mobile devices: Results from an antenatal feasibility study

Perinatal depression (PND) affects up to 15% of women within the United Kingdom and has a lasting impact on a woman’s quality of life, birth outcomes and her child’s development. Suicide is the leading cause of maternal mortality. However, it is estimated that at least 50% of PND cases go undiagnosed. This paper presents the results of the first feasibility study to examine the potential of mobile devices to engage women in antenatal mental health screening. Using a mobile application, 254 women attending 14 National Health Service midwifery clinics provided 2,280 momentary and retrospective reports of their wellbeing over a 9-month period. Women spoke positively of the experience, installing and engaging with this technology regardless of age, education, wellbeing, number of children, marital or employment status, or past diagnosis of depression. 39 women reported a risk of depression, self-harm or suicide; two-thirds of whom were not identified by screening in-clinic

Mapping mental health service access: achieving equity through quality improvement.

Background Improving access to psychological therapies (IAPTs) services deliver evidence-based care to people with depression and anxiety. A quality improvement (QI) initiative was undertaken by an IAPT service to improve referrals providing an opportunity to evaluate equitable access. Methods QI methodologies were used by the clinical team to improve referrals to the service. The collection of geo-coded data allowed referrals to be mapped to small geographical areas according to deprivation. Results A total of 6078 patients were referred to the IAPT service during the period of analysis and mapped to120 unique lower super output areas (LSOAs). The average weekly referral rate rose from 17 during the baseline phase to 43 during the QI implementation phase. Spatial analysis demonstrated all 15 of the high deprivation/low referral LSOAs were converted to high deprivation/high or medium referral LSOAs following the QI initiative. Conclusion This work highlights the importance of QI in developing clinical services aligned to the needs of the population through the analysis of routine data matched to health needs. Mapping can be utilized to communicate complex information to inform the planning and organization of clinical service delivery and evaluate the progress and sustainability of QI initiatives.</p

Tablet computers for implementing NICE antenatal mental health guidelines

Introduction: Perinatal depression can affect up to 20% of women during pregnancy or within a year of giving birth. Early identification of depressive symptoms is possible, but requires repeated interactions with the health system. We developed a smartphone app that reduces the need for frequent physical visits by enabling depression screening at home. We aim to assess the feasibility for using the app to measure severity of depressive symptoms among pregnant women. Methods: We used a parallel, randomised control trial study design. Participants were recruited from antenatal clinics and general practices across 10 NHS trusts. Following baseline screening, participants in arm one were required to complete the Edinburgh Postnatal Depression Scale (EPDS) monthly, while in arm two twice a month along with an Ecological Momentary Assessment and other contextual information. Follow-ups will continue for 6 months. Alerts were generated and communicated to the clinical team if a participant scored high on the EPDS. Results: 341 participants were recruited and, of those, 251 installed the app. Abnormal baseline scores and alerts have been followed up by a multidisciplinary team. Preliminary results will be presented. Conclusion: The use of mobile apps can aid toward the early detection and treatment of perinatal depression, while easing the demands on physicians and other health professionals