End-User Programming of Mobile Services: Empowering Domain Experts to Implement Mobile Data Collection Applications

The widespread use of smart mobile devices (e.g., in clinical trials or online surveys) offers promising perspectives with respect to the controlled collection of high-quality data. The design, implementation and deployment of such mobile data collection applications, however, is challenging in several respects. First, various mobile operating systems need to be supported, taking the short release cycles of vendors into account as well. Second, domain-specific requirements need to be flexibly aligned with mobile application development. Third, usability styleguides need to be obeyed. Altogether, this turns both programming and maintaining mobile applications into a costly, time-consuming, and error-prone endeavor. To remedy these drawbacks, a model-driven framework empowering domain experts to implement robust mobile data collection applications in an intuitive way was realized. The design of this end-user programming framework is based on experiences gathered in real-life mobile data collection projects. Facets of various stakeholders involved in such projects are discussed and an overall architecture as well as its components are presented. In particular, it is shown how the framework enables domain experts (i.e., end users) to flexibly implement mobile data collection applications on their own. Overall, the framework allows for the effective support of mobile services in a multitude of application domains

Preventing further trauma: KINDEX mum screen - assessing and reacting towards psychosocial risk factors in pregnant women with the help of smartphone technologies

The KINDEX mum screen has been designed to be administered by gynecologists and midwives during pregnancy for the assessment of the main psychosocial developmental risk factors, which include traumatic experiences of the parents, intimate partner violence, drug abuse, a history of mental health problems, poverty, acute stress, and others. In addition, we have developed a self-assessment version that runs on tablet computers (iPads). Validation of the KINDEX has been successfully completed in Germany, Spain, Greece, and Peru. Gynecologists or midwives interviewed 80120 pregnant women in each country. A randomized sub sample of respondents was assessed by trained clinical psychologists using standardized structural interviews to assess perceived stress and mental disorders. 14-months after giving birth the new mothers were interviewed again and the predictive value of the KINDEX was assessed by structured clinical interviews and the analysis of the cortisol levels (deposited in hair over a month) of mother and child as indicator for stress. The results show that the KINDEX assesses valid information about existing risk factors through a structured 15-minute interview with the pregnant women or through the application of this instrument as self-rating on a tablet computer. The tablet computer application in addition to the paperpencil version has the advantage of automatic analysis of the data and instant recommendation for further support of the pregnant woman

Detecting adverse childhood experiences with a little help from tablet computers

Adverse childhood experiences, ranging from abuse to emotional neglect, damage the mental and physical health and may impede the treatment of mental disorders. However, validated instruments that assess childhood adversity including the full range of childhood maltreatment are lacking. The adverse childhood experiences index (ACE; Dube et al., 2003; Felitti et al., 1998) retrospectively assessed different forms of abuse, neglect, and household dysfunctioning during the first 18 years of life, and quantified the ‘‘breadth of the experienced adversities’’, by means of the ACE score. Thus, this instrument allows quantifying the magnitude or ‘‘dose’’ of toxic childhood experiences. A recent modification of the ACE index, by Teicher and colleagues (2011, MACE Scale), gathers in even greater detailed and in more comprehensive ways information about the various types of maltreatment: self experienced abuse or neglect, as well as peer victimization and witnessing domestic violence are all explored in detail. Supplementary information gained about emotional reactions to the events, and temporal anchoring of the experienced, are highly valuable for psychotherapeutic and research purpose. We present short versions of the MACE and a pediatric version (Isele et al., in prep.), adjusted to the cognitive and emotional development status of minors. These new versions fill the need for structured clinical interviews, mapping abuse, and neglect in this sample. Their application in clinical research and therapeutic contexts is shown including an electronic tablet-computer supported assessment

A generic questionnaire framework supporting psychological studies with smartphone technologies

Many psychological studies are performed with specifically tailored ‘‘paper & pencil’’-questionnaires. Such a paper-based approach usually results in a massive workload for evaluating and analyzing the collected data afterwards, e.g., to transfer data to electronic worksheets or any statistics software. To relieve researchers from such manual tasks and to improve the efficiency of data collection processes, we realized smart device applications for existing psychological questionnaires (e.g., the KINDEX, PDS, or CAPS questionnaire). Based on these applications, we were able to demonstrate the usefulness of smart devices (e.g., smartphones or tablets) for mobile data collection in the context of psychological questionnaires. Although the implemented applications already have shown several advantages in respect to data collection and analysis, they have not been suitable for psychological studies in the large scale yet, e.g., due to the high maintenance efforts for the psychologists. More precisely, changes to a questionnaire or its structure still must be accomplished by computer scientists, since its implementation is hard-coded. What is needed instead is an easy-to-use and self-explaining framework for creating, running, and evolving the questionnaires of psychological studies on mobile and smart devices. In this context, supporting the complete questionnaire lifecycle is essential, i.e., IT support for creating, using, evaluating, and archiving questionnaires is required to assist end-users having no programming background. We present our generic questionnaire framework, which encompasses the following three parts: a questionnaire configurator to create the questions and questionnaires, a way of integrating mobile devices to deploy, run and log questionnaires, and a middleware enabling a secure data exchange. Finally, we discuss how smartphone technology and mobile devices can be used to suitably support psychologists in their daily work with questionnaires. As major benefit of the framework, better data quality, shorter evaluation cycles, and significant decreases in workload will result

Psychopathological sequelae of female genital mutilation and their neuroendocrinological associations

Abstract Background Anecdotal evidence suggests the frequently traumatic nature of female genital mutilation (FGM). At present, systematic research on the psychological sequelae of this tradition has remained limited. The study provides preliminary, high-quality psychodiagnostic data on potential psychopathological consequences of FGM, with a focus on posttraumatic stress disorder (PTSD), shutdown dissociation and other stress-related variables. Methods We investigated a convenience sample of N = 167 women, supported by the women’s affairs headquarters in Jijiga (capital of the Ethiopian Somali Region) and a local Ethiopian non-governmental organization. Our main outcome measures were PTSD (PSS-I) and shutdown dissociation (ShuD). We also assessed depression and anxiety (HSCL-25), major depression, substance abuse and dependence, suicidality and psychotic disorders (M.I.N.I.; sub-scales A., B., K., and L.). In addition, we collected hair samples to assess hair cortisol concentrations (HCC) as a neuroendocrinological measure. Results The majority of women endured FGM (FGM I: 36%, FGM II/III: 52%) and, regardless of the level of the physical invasiveness, almost all women reported having felt intense fear and/or helplessness. FGM II/III, the more invasive form, was associated with a greater vulnerability to PTSD symptoms (p < .001) and shutdown dissociation (p < .001). Symptoms of depression (p < .05) and anxiety (p < .01) were also elevated. Random forest regression with conditional inference trees revealed evidence of an alteration of the cortisol levels in relation to the age when FGM was experienced (< 1 year) and the invasiveness of the procedure. Conclusion More extensive forms of FGM are associated with more severe psychopathological symptoms – particularly with an increased vulnerability to PTSD. Higher hair cortisol levels in women who experienced FGM before their first year of age or had more severe forms of FGM indicate long-term neuroendocrinological consequences of FGM and trauma in general on the stress system

Prenatal screening for psychosocial risks in a high risk-population in Peru using the KINDEX interview

BackgroundPrenatal stress and other prenatal risk factors (e.g. intimate partner violence) have a negative impact on mother’s health, fetal development as well as enduring adverse effects on the neuro-cognitive, behavioral and physical health of the child. Mothers of low socio-economic status and especially those living in crime-ridden areas are even more exposed to a host of risk factors. Societies of extreme violence, poverty and inequalities, often present difficulties to provide adequate mental health care to the most needed populations. The KINDEX, a brief standardized instrument that assesses 11 different risk factors was used by midwives to identify pregnant women at-risk, in a suburban area with one of the highest levels of domestic violence in Lima. The instrument was designed to be used by medical staff to identify high-risk child-bearing women and, based on the results, to refer them to the adequate psychological or social support providers. The aim of this study is to assess the feasibility of psychosocial screening using the KINDEX in a Latin American Country for the first time, and to explore the relationship of the KINDEX with thee major risk areas, maternal psychopathology, perceived stress and traumatic experiences.MethodsThe study was conducted in cooperation with the gynecological department of a general hospital in a suburban area of Lima. Nine midwives conducted interviews using the KINDEX of ninety-five pregnant women attending the gynecological unit of the hospital. From these, forty pregnant women were re-interviewed by a clinical psychologist using established instruments in order to assess the feasibility of the prenatal assessment in public health settings and the relationship of the KINDEX with maternal perceived stress, psychopathology symptoms and trauma load during pregnancy.ResultsWe found high rates of risk factors in the examined pregnant women comparable with those found in the general population. Significant correlations were found between the KINDEX sum score and the three risks areas, stress, psychopathology and trauma load as assessed in the Clinical Expert interviews. The different risks assessed by the KINDEX are related to higher levels of stress, psychopathology and trauma load, depending on the risk.ConclusionsThe relationship between past adverse experience and current stressors with perceived maternal stress, psychopathology symptoms and traumatic experiences confirm the importance of prenatal assessment for psychosocial risks. The use of KINDEX by midwives providing obstetrical care to pregnant women in urban Peru is feasible and can be used to identify high-risk women and refer them to the adequate mental health or social services for necessary attention and support. Early interventions are essential to mitigating the adverse effects of maternal stress, trauma and psychopathology on the fetus and child.publishe

Obstetric care providers are able to assess psychosocial risks, identify and refer high-risk pregnant women : validation of a short assessment tool - the KINDEX Greek version

BACKGROUND: Prenatal assessment for psychosocial risk factors and prevention and intervention is scarce and, in most cases, nonexistent in obstetrical care. In this study we aimed to evaluate if the KINDEX, a short instrument developed in Germany, is a useful tool in the hands of non-trained medical staff, in order to identify and refer women in psychosocial risk to the adequate mental health and social services. We also examined the criterion-related concurrent validity of the tool through a validation interview carried out by an expert clinical psychologist. Our final objective was to achieve the cultural adaptation of the KINDEX Greek Version and to offer a valid tool for the psychosocial risk assessment to the obstetric care providers. METHODS: Two obstetricians and five midwives carried out 93 KINDEX interviews (duration 20 minutes) with pregnant women to assess psychosocial risk factors present during pregnancy. Afterwards they referred women who they identified having two or more psychosocial risk factors to the mental health attention unit of the hospital. During the validation procedure an expert clinical psychologist carried out diagnostic interviews with a randomized subsample of 50 pregnant women based on established diagnostic instruments for stress and psychopathology, like the PSS-14, ESI, PDS, HSCL-25. RESULTS: Significant correlations between the results obtained through the assessment using the KINDEX and the risk areas of stress, psychopathology and trauma load assessed in the validation interview demonstrate the criterion-related concurrent validity of the KINDEX. The referral accuracy of the medical staff is confirmed through comparisons between pregnant women who have and have not been referred to the mental health attention unit. CONCLUSIONS: Prenatal screenings for psychosocial risks like the KINDEX are feasible in public health settings in Greece. In addition, validity was confirmed in high correlations between the KINDEX results and the results of the validation interviews. The KINDEX Greek version can be considered a valid tool, which can be used by non-trained medical staff providing obstetrical care to identify high-risk women and refer them to adequate mental health and social services. These kind of assessments are indispensable for the promotion of a healthy family environment and child development

Obstetric care providers assessing psychosocial risk factors during pregnancy : validation of a short screening tool - the KINDEX Spanish version

BackgroundHigh levels of stress due to diverse psychosocial factors have a direct impact on the mothers’ wellbeing during pregnancy and both direct and indirect effects on the fetus. In most cases, psychosocial risk factors present during pregnancy will not disappear after delivery and might influence the parent-child relationship, affecting the healthy development of the offspring in the long term.We introduce a short innovative prenatal assessment to detect psychosocial risk factors through an easy to use instrument for obstetrical medical staff in the daily clinical practice, the KINDEX Spanish Version.MethodsIn the present study midwives and gynecologists interviewed one hundred nineteen pregnant women in a public health center using the KINDEX Spanish Version. Sixty-seven women were then randomly selected to participate in an extended standardized validation interview conducted by a clinical psychologist using established questionnaires to assesses current stress (ESI, PSS-14), symptoms of psychopathology (HSCL-25, PDS) and traumatic experiences (PDS, CFV). Ethical approval was granted and informed consent was required for participation in this study.ResultsThe KINDEX sum score, as assessed by medical staff, correlated significantly with stress, psychopathology and trauma as measured during the clinical expert interview. The KINDEX shows strong concurrent validity. Its use by medical staff in daily clinical practice is feasible for public health contexts. Certain items in the KINDEX are related to the respective scales assessing the same risks (e.g.PSS-4 as the shorter version of the PSS-14 and items from the ESI) used in the validation interview.ConclusionsThe KINDEX Spanish Version is a valid tool in the hands of medical staff to identify women with multiple psychosocial risk factors in public health settings. The KINDEX Spanish Version could serve as a base-instrument for the referral of at-risk women to appropriate psychosocial intervention. Such early interventions could prove pivotal in preventing undesirable mother-child relationships and adverse child development