In Case of an Emergency: The Development and Effects of a Digital Intervention for Coping With Distress in Norway During the COVID-19 Pandemic

Background: The COVID-19 pandemic and its consequences has been found to negatively affect the general population’s psychological well-being. Objective: The objectives of this paper are to report on the development and clinical effects of a self-guided Internet-delivered intervention for adults in Norway who suffer from mild to moderate psychological distress during the COVID-19 pandemic. Methods: The participants, recruited between April and December 2020, were randomized to receive a new treatment module either every third or every fifth day. The clinical outcomes were self-reported depressive and anxiety symptoms and change in positive and negative emotions. Results: A total of 1256 individuals accessed the pre-screening survey, 407 were eligible and 92 provided contact information, where 82 were included in the study, n = 44 in the 3-day group and n = 38 in the 5-day group. Overall, the statistical analyses showed a significant decrease in depressive and anxiety symptoms and an increase in positive emotions, with small and moderate within group effect sizes. No significant differences between the groups were identified in clinical outcomes or adherence. Conclusion: These findings indicate that psychological distress in the general population during the COVID-19 pandemic may be reduced through the use of a scalable self-guided Internet-delivered intervention. Furthermore, the lack of significant differences between the 5-day and 3-day group may indicate that the intervention can be delivered at a more intensive pace without negatively affecting treatment outcomes. The results need to be interpreted with caution as the sample was self-selected, as well as the lack of passive control group. Hence the results may be attributed to external factors.publishedVersio

Development of a framework and the content for a psychoeducational internet-delivered intervention for women after treatment for gynaecological cancer

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).The number of women treated for gynecological cancer is increasing. At the same time, the duration of in-patient hospitalization has decreased, and follow-up with its primary focus on early recognition of recurrence does not meet all patients’ needs. One method of follow-up may be digital intervention. This study describes the development of a psychoeducational Internetdelivered intervention targeting women’s psychosocial needs during the follow-up period after treatment for gynecological cancer. The project consisted of three phases following the UK Medical Research Council Framework guidelines for the development of complex interventions. Phase one identified the evidence in the field, phase two identified the relevant theoretical framework, and phase three included a two-year work process including focus group interviews and think aloud interviews with users. Through the steps of literature review, theoretical framework, and an iterative development process with users and other stakeholders, a six-week program was developed. The program included psychoeducational information, multimedia, exercises, and weekly telephone follow-up with a dedicated nurse. This Internet-delivered intervention can be a novel method for addressing the gap in the provision of follow-up for women after treatment for gynecological cancer.publishedVersio

Designing Videos with and for Adults with ADHD for an Online Intervention: Participatory Design Study and Thematic Analysis of Evaluation

Background: Adults with attention deficit hyperactivity disorder (ADHD) represent a heterogeneous group with both strengths and difficulties associated with the diagnosis. An online intervention attuned to their needs may improve their everyday functioning. When designing online interventions, it is important to adapt the therapeutic content to the values and needs of the target group. Objective: This paper describes and evaluates a participatory process used to produce content for an online intervention for adults with ADHD by producing video vignettes clarifying core training principles grounded in the participants' everyday experiences. Methods: We report on the qualitative data from 2 research phases: the design and evaluation of video vignettes for an online intervention. In the first phase, 12 adults with ADHD, 2 clinicians, and 2 research assistants participated in the production of video vignettes for the online intervention. In the second phase, participants (n=109) gave feedback on the videos as part of a clinical trial of the intervention. A subgroup (n=7) was interviewed in-depth regarding their experiences with the videos. The qualitative data were analyzed using thematic analysis. Results: In the first phase, the participants with ADHD contributed with experiences from challenging everyday situations. In the process, we navigated between therapeutic principles and the participants' experiential perspectives to create content relevant and consistent with the target group's values and experiences. In the second phase, we identified 3 themes related to the participants' experiences and interpretation of the video vignettes: (1) recognition of ADHD-related challenges, (2) connection with the characters and the situations, and (3) video protagonists as companions and role models for change. Conclusions: A participatory design process for designing online mental health interventions can be used to probe and balance between the therapeutic principles defined by clinicians and the participants’ experiences with mental health issues in the production of therapeutic content. In our study, the inclusion of video vignettes in an online intervention enabled a contextualized and relevant presentation of everyday experiences and psychosocial factors in the life of an adult with ADHD.publishedVersio

Towards Adaptive Technology in Routine Mental Healthcare

This paper summarizes the information technology-related research findings after 5 years with the INTROducing Mental health through Adaptive Technology project. The aim was to improve mental healthcare by introducing new technologies for adaptive interventions in mental healthcare through interdisciplinary research and development. We focus on the challenges related to internet-delivered psychological treatments, emphasising artificial intelligence, human-computer interaction, and software engineering. We present the main research findings, the developed artefacts, and lessons learned from the project before outlining directions for future research. The main findings from this project are encapsulated in a reference architecture that is used for establishing an infrastructure for adaptive internet-delivered psychological treatment systems in clinical contexts. The infrastructure is developed by introducing an interdisciplinary design and development process inspired by domain-driven design, user-centred design, and the person based approach for intervention design. The process aligns the software development with the intervention design and illustrates their mutual dependencies. Finally, we present software artefacts produced within the project and discuss how they are related to the proposed reference architecture. Our results indicate that the proposed development process, the reference architecture and the produced software can be practical means of designing adaptive mental health care treatments in correspondence with the patients’ needs and preferences. In summary, we have created the initial version of an information technology infrastructure to support the development and deployment of Internet-delivered mental health interventions with inherent support for data sharing, data analysis, reusability of treatment content, and adaptation of intervention based on user needs and preferences.publishedVersio

Meaningful Engagement with Digital Health Interventions : Experience, Participation and Design

Avhandlingen utforsker meningsfylt engasjement (engelsk: engagement) med digitale helseintervensjoner (DHI). Med dette tar avhandlingen sikte på å utvide engasjementsbegrepet fra et erfaringsmessig perspektiv, spesielt med hensyn til hvordan vi konstruerer mening fra våre interaksjoner med DHI-er. Et ytterligere mål med denne avhandlingen er å forstå hvordan vi kan designe for meningsfylt engasjement og hvordan brukerinvolvering kan konfigureres når vi utvikler DHI-er for mental helse-domenet. Avhandlingen består av tre forskningsartikler, som hver utforsker deltakende design av forskjellige DHI-er, inkludert empiriske studier av folks erfaringer med designprototypene. Den første artikkelen utforsker hvordan ungdom kan bidra til utformingen av eksponeringsterapi for virtuell virkelighet (VR) som med-designere i en deltakende designworkshop. Ved å bruke sin levde erfaringer av å være elever på videregående, utformet ungdommene realistiske og autentiske VR-scenarier som ga en oversikt over settingene der frykt for å snakke offentlig kan oppstå for ungdom. Den andre artikkelen utforsker hvordan eksisterende kvalitative studier av sykdom kan brukes med innspill fra erfaringseksperter som innspill i utviklingen av DHI-er. I samarbeid med tidligere gynekologiske kreftpasienter utformet vi audiovisuelle fortellinger som støtter overlevende etter kreft i å reflektere over deres erfaringer. Den empiriske studien beskriver hvordan tidligere kreftpasienter opplevde narrativene som relevante for deres levde erfaringer og meningsfulle når de reflekterte over egne erfaringer. Den tredje artikkelen presenterer en deltakende designprosess for å designe videovignetter for en DHI som støtter voksne med ADHD i å håndtere hverdagen. En omfattende evalueringsstudie av en DHI som brukte disse videoene beskrev hvordan voksne med ADHD forholdt seg til karakterene og deres situasjoner, og fant trøst og inspirasjon i å se andre slite med liknende utfordringer og takle hverdagssituasjoner. Studiene danner det empiriske grunnlaget for oppgavens bidrag til Human-Computer Interaction (HCI) og DHI-forskning. Et sentralt bidrag til denne oppgaven er introduksjonen av meningsfylt engasjement som en konseptuell linse for å forstå engasjement med DHI-er ytterligere. Konseptet består av dets tre knyttede dimensjoner: målrettet interaksjon, følt opplevelse og meningsskaping. Jeg gir et ytterligere bidrag ved å vise hvordan erfaring og narrativ kan brukes som ressurser i design som bidrar til et meningsfullt engasjement med DHI-er. Oppgaven konkluderer med at en deltakende tilnærming til utforming av DHI-er som involverer personer med levd erfaring av sykdom kan gi et unikt, erfaringsmessig perspektiv i designprosessen som kan legge til rette for personlig relevante og autentiske opplevelser med DHI-er.This thesis explores meaningful engagement with digital health interventions (DHI). By this, the thesis aims to expand upon the engagement concept from an experiential perspective, in particular in how people construct meaning from their interactions with DHIs. A further aim of this thesis is to understand how we can design for meaningful engagement and how user involvement can be configured when creating DHIs for the mental health domain. The thesis consists of three papers, each exploring participatory design of different DHIs, including empirical studies of people's experiences with the design prototypes. The first paper explores how adolescents can contribute to the design of virtual reality (VR) exposure therapy as co-designers in a participatory design workshop. By using their lived experience of being high school students, the adolescents designed realistic and authentic VR scenarios that provided a view of the settings in which fear of public speaking can occur for adolescents. The second paper explores how existing qualitative studies of illness can be used with the input from experts by experience to inform the design of DHIs. In collaboration with former gynecological cancer patients, we designed audiovisual narratives that support survivors of cancer in reflecting on their experiences. The empirical study describes how former cancer patients experienced the narratives as relevant to their lived experience and meaningful when reflecting on their own experiences. The third paper presents a participatory design process of designing video vignettes for a DHI that supports adults with ADHD in managing everyday life. A comprehensive evaluation study of the DHI that used these videos described how people with ADHD related to the characters and their situations, finding comfort and inspiration in seeing others struggle and cope with everyday life situations. The studies form the empirical underpinning of the thesis' contributions to Human-Computer Interaction (HCI) and DHI research. A key contribution of this thesis is the introduction of meaningful engagement as a conceptual lens to further understand engagement with DHIs. The concept is made up by its three interconnected dimensions: purposeful interaction, felt experience, and sense-making. I make a further contribution by showing how experience and narrative can be used as resources for design to help facilitate meaningful engagement with DHIs. The thesis concludes that a participatory approach to designing DHIs that involves people with the lived experience of illness can provide a unique, experiential perspective in the design process that can facilitate personally relevant and authentic experiences with DHIs.Doktorgradsavhandlin

Participatory Design of VR Scenarios for Exposure Therapy

Virtual reality (VR) applications for exposure therapy predominantly use computer-generated imagery to create controlled environments in which users can be exposed to their fears. Creating 3D animations, however, is demanding and time-consuming. This paper presents a participatory approach for prototyping VR scenarios that are enabled by 360° video and grounded in lived experiences. We organized a participatory workshop with adolescents to prototype such scenarios, consisting of iterative phases of ideation, storyboarding, live-action plays recorded by a 360° camera, and group evaluation. Through an analysis of the participants’ interactions, we outline how they worked to design prototypes that depict situations relevant to those with a fear of public speaking. Our analysis also explores how participants used their experiences and reflections as resources for design. Six clinical psychologists evaluated the prototypes from the workshop and concluded they were viable therapeutic tools, emphasizing the immersive, realistic experience they presented. We argue that our approach makes the design of VR scenarios more accessible.Participatory Design of VR Scenarios for Exposure Therap

In Case of an Emergency: The Development and Effects of a Digital Intervention for Coping With Distress in Norway During the COVID-19 Pandemic

Background: The COVID-19 pandemic and its consequences has been found to negatively affect the general population’s psychological well-being. Objective: The objectives of this paper are to report on the development and clinical effects of a self-guided Internet-delivered intervention for adults in Norway who suffer from mild to moderate psychological distress during the COVID-19 pandemic. Methods: The participants, recruited between April and December 2020, were randomized to receive a new treatment module either every third or every fifth day. The clinical outcomes were self-reported depressive and anxiety symptoms and change in positive and negative emotions. Results: A total of 1256 individuals accessed the pre-screening survey, 407 were eligible and 92 provided contact information, where 82 were included in the study, n = 44 in the 3-day group and n = 38 in the 5-day group. Overall, the statistical analyses showed a significant decrease in depressive and anxiety symptoms and an increase in positive emotions, with small and moderate within group effect sizes. No significant differences between the groups were identified in clinical outcomes or adherence. Conclusion: These findings indicate that psychological distress in the general population during the COVID-19 pandemic may be reduced through the use of a scalable self-guided Internet-delivered intervention. Furthermore, the lack of significant differences between the 5-day and 3-day group may indicate that the intervention can be delivered at a more intensive pace without negatively affecting treatment outcomes. The results need to be interpreted with caution as the sample was self-selected, as well as the lack of passive control group. Hence the results may be attributed to external factors

Participatory Design of VR Scenarios for Exposure Therapy

Virtual reality (VR) applications for exposure therapy predominantly use computer-generated imagery to create controlled environments in which users can be exposed to their fears. Creating 3D animations, however, is demanding and time-consuming. This paper presents a participatory approach for prototyping VR scenarios that are enabled by 360° video and grounded in lived experiences. We organized a participatory workshop with adolescents to prototype such scenarios, consisting of iterative phases of ideation, storyboarding, live-action plays recorded by a 360° camera, and group evaluation. Through an analysis of the participants’ interactions, we outline how they worked to design prototypes that depict situations relevant to those with a fear of public speaking. Our analysis also explores how participants used their experiences and reflections as resources for design. Six clinical psychologists evaluated the prototypes from the workshop and concluded they were viable therapeutic tools, emphasizing the immersive, realistic experience they presented. We argue that our approach makes the design of VR scenarios more accessible

Designing Videos with and for Adults with ADHD for an Online Intervention: Participatory Design Study and Thematic Analysis of Evaluation

Background: Adults with attention deficit hyperactivity disorder (ADHD) represent a heterogeneous group with both strengths and difficulties associated with the diagnosis. An online intervention attuned to their needs may improve their everyday functioning. When designing online interventions, it is important to adapt the therapeutic content to the values and needs of the target group. Objective: This paper describes and evaluates a participatory process used to produce content for an online intervention for adults with ADHD by producing video vignettes clarifying core training principles grounded in the participants' everyday experiences. Methods: We report on the qualitative data from 2 research phases: the design and evaluation of video vignettes for an online intervention. In the first phase, 12 adults with ADHD, 2 clinicians, and 2 research assistants participated in the production of video vignettes for the online intervention. In the second phase, participants (n=109) gave feedback on the videos as part of a clinical trial of the intervention. A subgroup (n=7) was interviewed in-depth regarding their experiences with the videos. The qualitative data were analyzed using thematic analysis. Results: In the first phase, the participants with ADHD contributed with experiences from challenging everyday situations. In the process, we navigated between therapeutic principles and the participants' experiential perspectives to create content relevant and consistent with the target group's values and experiences. In the second phase, we identified 3 themes related to the participants' experiences and interpretation of the video vignettes: (1) recognition of ADHD-related challenges, (2) connection with the characters and the situations, and (3) video protagonists as companions and role models for change. Conclusions: A participatory design process for designing online mental health interventions can be used to probe and balance between the therapeutic principles defined by clinicians and the participants’ experiences with mental health issues in the production of therapeutic content. In our study, the inclusion of video vignettes in an online intervention enabled a contextualized and relevant presentation of everyday experiences and psychosocial factors in the life of an adult with ADHD