Employing Environmental Data and Machine Learning to Improve Mobile Health Receptivity

Behavioral intervention strategies can be enhanced by recognizing human activities using eHealth technologies. As we find after a thorough literature review, activity spotting and added insights may be used to detect daily routines inferring receptivity for mobile notifications similar to just-in-time support. Towards this end, this work develops a model, using machine learning, to analyze the motivation of digital mental health users that answer self-assessment questions in their everyday lives through an intelligent mobile application. A uniform and extensible sequence prediction model combining environmental data with everyday activities has been created and validated for proof of concept through an experiment. We find that the reported receptivity is not sequentially predictable on its own, the mean error and standard deviation are only slightly below by-chance comparison. Nevertheless, predicting the upcoming activity shows to cover about 39% of the day (up to 58% in the best case) and can be linked to user individual intervention preferences to indirectly find an opportune moment of receptivity. Therefore, we introduce an application comprising the influences of sensor data on activities and intervention thresholds, as well as allowing for preferred events on a weekly basis. As a result of combining those multiple approaches, promising avenues for innovative behavioral assessments are possible. Identifying and segmenting the appropriate set of activities is key. Consequently, deliberate and thoughtful design lays the foundation for further development within research projects by extending the activity weighting process or introducing a model reinforcement.BMBF, 13GW0157A, Verbundprojekt: Self-administered Psycho-TherApy-SystemS (SELFPASS) - Teilvorhaben: Data Analytics and Prescription for SELFPASSTU Berlin, Open-Access-Mittel - 201

Community perspectives on the benefits and risks of technologically enhanced communicable disease surveillance systems: A report on four community juries

Background Outbreaks of infectious disease cause serious and costly health and social problems. Two new technologies – pathogen whole genome sequencing (WGS) and Big Data analytics – promise to improve our capacity to detect and control outbreaks earlier, saving lives and resources. However, routinely using these technologies to capture more detailed and specific personal information could be perceived as intrusive and a threat to privacy. Method Four community juries were convened in two demographically different Sydney municipalities and two regional cities in New South Wales, Australia (western Sydney, Wollongong, Tamworth, eastern Sydney) to elicit the views of well-informed community members on the acceptability and legitimacy of: making pathogen WGS and linked administrative data available for public health research using this information in concert with data linkage and machine learning to enhance communicable disease surveillance systems Fifty participants of diverse backgrounds, mixed genders and ages were recruited by random-digit-dialling and topic-blinded social-media advertising. Each jury was presented with balanced factual evidence supporting different expert perspectives on the potential benefits and costs of technologically enhanced public health research and communicable disease surveillance and given the opportunity to question experts. Results Almost all jurors supported data linkage and WGS on routinely collected patient isolates for the purposes of public health research, provided standard de-identification practices were applied. However, allowing this information to be operationalised as a syndromic surveillance system was highly contentious with three juries voting in favour, and one against by narrow margins. For those in favour, support depended on several conditions related to system oversight and security being met. Those against were concerned about loss of privacy and did not trust Australian governments to run secure and effective systems. Conclusions Participants across all four events strongly supported the introduction of data linkage and pathogenomics to public health research under current research governance structures. Combining pathogen WGS with event-based data surveillance systems, however, is likely to be controversial because of a lack of public trust, even when the potential public health benefits are clear. Any suggestion of private sector involvement or commercialisation of WGS or surveillance data was unanimously rejected

Mental Health Among Medical Professionals During the COVID-19 Pandemic in Eight European Countries: Cross-sectional Survey Study

BACKGROUND The death toll of COVID-19 topped 170,000 in Europe by the end of May 2020. COVID-19 has caused an immense psychological burden on the population, especially among doctors and nurses who are faced with high infection risks and increased workload. OBJECTIVE The aim of this study was to compare the mental health of medical professionals with nonmedical professionals in different European countries during the COVID-19 pandemic. We hypothesized that medical professionals, particularly those exposed to COVID-19 at work, would have higher levels of depression, anxiety, and stress. We also aimed to determine their main stressors and most frequently used coping strategies during the crisis. METHODS A cross-sectional online survey was conducted during peak COVID-19 months in 8 European countries. The questionnaire included demographic data and inquired whether the participants were exposed to COVID-19 at work or not. Mental health was assessed via the Depression Anxiety Stress Scales32 (23.53)-21 (DASS-21). A 12-item checklist on preferred coping strategies and another 23-item questionnaire on major stressors were completed by medical professionals. RESULTS The sample (N=609) consisted of 189 doctors, 165 nurses, and 255 nonmedical professionals. Participants from France and the United Kingdom reported experiencing severe/extremely severe depression, anxiety, and stress more often compared to those from the other countries. Nonmedical professionals had significantly higher scores for depression and anxiety. Among medical professionals, no significant link was reported between direct contact with patients with COVID-19 at work and anxiety, depression, or stress. "Uncertainty about when the epidemic will be under control" caused the most amount of stress for health care professionals while "taking protective measures" was the most frequently used coping strategy among all participants. CONCLUSIONS COVID-19 poses a major challenge to the mental health of working professionals as a considerable proportion of our participants showed high values for depression, anxiety, and stress. Even though medical professionals exhibited less mental stress than nonmedical professionals, sufficient help should be offered to all occupational groups with an emphasis on effective coping strategies

Zwischen Selbstfürsorge und Selbstoptimierung: Zur Wirkung von Internet und sozialen Medien auf die Identität psychisch unbelasteter und belasteter Menschen im Generationenvergleich

Individualisierung wird als tiefgreifender gesellschaftlicher Wandel beschrieben, der spätestens im 20. Jahr-hundert dazu geführt habe, dass Menschen persönliche Entscheidungen hin-sichtlich ihrer Lebensgestaltung losgelöst von Traditionen und Normen treffen. Diese Freiheit wird zugleich als Erwartungsdruck gesehen, da die Forderung ein möglichst einzigartiges Leben zu führen schon mit Einsetzen der Adoleszenz verinnerlicht wird und einen hohen Druck ausüben kann, der potenziell zu psychischen Belastungen führt. Die Digitalisierung, insbesondere der zunehmende personalisierbare Gebrauch des Internets und sozialer Medien, gilt in diesem Zusammenhang als weiterer Faktor, der die Individualisierung vorangetrieben hat. Einerseits bietet das Internet nie zuvor dagewesene Möglichkeiten, zu jedem Zeitpunkt und an jedem Ort soziale Vergleiche vorzunehmen und sich damit sozial zu positionieren, andererseits ist Selbstdarstellung über Profile in sozialen Medien Teil der Technologie. Die vorliegende Studie hat zum Ziel zu untersuchen, ob eine fortschreitende Individualisierung über mehrere Generationen hinweg beobachtbar ist und ob das Internet und soziale Medien dazu beitragen. Außerdem soll der Frage nachgegangen werden, ob mit dieser Entwicklung psychische Belastungen einhergehen. Es handelt sich um eine Querschnittsstudie im Mixed-Methods-Design, bei der zunächst sechs Fokusgruppen mit insgesamt 36 Probanden der Generationen Baby Boomer (1950-1965), Generation X (1965-1980) und Digital Natives (1981-2000) durchgeführt worden sind. Im zweiten Schritt wurden 47 Einzelinterviews mit Probanden der genannten Generationen durchgeführt, die zu gleichen Teilen aus Probanden ohne und mit einer Diagnose im psychosomatischen Behandlungsspektrum bestanden. Diese führten im Anschluss über zwei Tage hinweg ein Selbstbeobachtungsprotokoll über ihre Mediennutzung und füllten Fragebögen zu den psychometrischen Skalen Depressivität/Ängstlichkeit, Technikbereitschaft und Generalisierte Selbstwirksamkeitserwartung aus. Das Handy war das von allen am häufigsten verwendete Gerät, um im Internet und sozialen Medien aktiv zu sein. Die Digital Natives griffen auf das Internet und soziale Medien mit der größten täglichen Nutzungsdauer zu, die Generation X etwas mehr als die Baby Boomer. Die Mehrheit der Probanden nutzte zwei bis sieben soziale Netzwerke. Insgesamt wurden etwa 15 Aktivitäten täglich protokolliert. Ein Anstieg an Individualisierung über die Generationen hinweg und ein möglicher Beitrag des Internets und sozialer Medien zu dieser Entwicklung konnte in mehrfacher Hinsicht aufgezeigt werden. Die jüngste Generation äußerte die meisten Facetten an Selbstbezogenheit in den Fokusgruppen und Interviews. Auch war die Beziehungsrichtung ihrer Aktivitäten und die der Generation X in den Selbstbeobachtungsprotokollen häufiger als bei den Baby Boomern auf die eigene Person bezogen als auf ein virtuelles Gegenüber. Die Generation der Baby Boomer setzte das Internet und soziale Medien in einer pragmatischen Weise für Kommunikation, Informationssuche und die Anforderungen des Alltags ein, die beiden jüngeren Genera¬tionen dagegen suchten neben Kommunikation auch vielfältige Möglichkeiten im Umgang mit sich selbst beispielsweise Unterhaltung, Spiel und Musik. Das emotionale Erleben im Anschluss an die Aktivitäten war in allen Altersgruppen überwiegend positiv, allerdings äußerten die Digital Natives im Verhältnis zu den anderen am stärksten auch negative Gefühle wie Gereiztheit oder Langeweile. Sie berichteten von durch Peer Group und Elterngeneration transportierte Erwartungen, stets online erreichbar sein zu müssen. Auch standen sie in einem starken sozialen Vergleich durch online vermittelte Inhalte. Schließlich äußerten sie am stärksten den Wunsch nach Selbstverbesserung. Dies stand in einem positiven Zusammenhang zu erlebter Einsamkeit. Self-Tracking-Technologien wurden von ihnen am intensivsten genutzt. Diese wurden überwiegend positiv erlebt. Kein Unterschied dagegen bestand in den Generationen hinsichtlich Selbstfürsorge und dem Erleben von Einsamkeit in der Gegenwart. Das Erleben von Selbstfürsorge war indes für die Baby Boomer in deren Ver-gangenheit stärker als in den anderen Generationen. Die Aktivitäten in den Selbstbeobachtungsprotokollen wurden bei Probanden ohne eine Diagnose im psychosomatischen Behandlungsspektrum häufiger von positiven Gefühlen gefolgt als von negativen oder neutralen Gefühlen. Probanden dieser Gruppe nutzten Aktivitäten wie Kommunikation, Alltag und Informationssuche am häufigsten, bei Probanden mit einer Diagnose stand Unterhaltung nach Kommunikation an zweiter Stelle. Bei Probanden mit einer derartigen Diagnose überwogen positive Gefühle nur in geringem Maß. Besonders online-Kommunikation und die Bewältigung des Alltags lösten häufiger auch negative Gefühle wie Gereiztheit, Nachdenklichkeit oder Trauer aus. Die Generationen unterschieden sich in ihren Belastungen dahingehend, dass die Baby Boomer höhere Werte im Bereich Depressivität aufwiesen als die anderen Generationen, dagegen zeigten die Digital Natives, wenn sie belastet waren, ein erhöhtes Maß an Ängstlichkeit. Es wurden keine Zusammenhänge zwischen Ausprägungen von Individualisierung und Technikbereitschaft ermittelt. Ein Zusammenhang zur generalisierten Selbstwirksamkeitserwartung bestand für den Bereich der Selbstfürsorge, jedoch nicht für den Wunsch nach Selbstverbesserung. Die Ergebnisse verdeutlichen, dass in den jüngeren Generationen eine stärkere Selbst-Bezogenheit be-obachtbar war als in den älteren und dass das Internet und soziale Medien bei dieser Entwicklung eine prägende Rolle spielen. Insbesondere soziale Vergleichsprozesse und die Vermittlung von Normen und Erwartungen werden durch die Kommunikation über soziale Netzwerke befördert. Davon können sich ältere Generationen leichter abgrenzen, für die jüngste Generation scheitern Distanzierungsversuche oft, was als psychisch belastend erlebt werden kann. Andere Aspekte der Technologie, wie beispielsweise Self-Tracking, können unterstützende Wege der Selbstfürsorge und Selbst-Wirksamkeit bieten. Ob es sich bei den genannten Ergebnissen um Generations- oder um Alterseffekte handelt, kann mittels des vorliegenden Untersuchungsdesigns nicht beantwortet werden. Weitere methodische Ansätze sind nötig, um besondere Belastungsprofile für die einzelnen Altersgruppen herauszuarbeiten und in Zeiten fortschreitender Individualisierung besonders die positiven Möglichkeiten von Selbstfürsorge zu stärken

Validity and Reliability of the Self-administered Psycho-TherApy-SystemS (SELFPASS) Item Pool for the Daily Mood Tracking of Depressive Symptoms: Cross-sectional Web-Based Survey

Backgrounde-Mental health apps targeting depression have gained increased attention in mental health care. Daily self-assessment is an essential part of e-mental health apps. The Self-administered Psycho-TherApy-SystemS (SELFPASS) app is a self-management app to manage depressive and comorbid anxiety symptoms of patients with a depression diagnosis. A self-developed item pool with 40 depression items and 12 anxiety items is included to provide symptom-specific suggestions for interventions. However, the psychometric properties of the item pool have not yet been evaluated. ObjectiveThe aim of this study is to investigate the validity and reliability of the SELFPASS item pool. MethodsA weblink with the SELFPASS item pool and validated mood assessment scales was distributed to healthy subjects and patients who had received a diagnosis of a depressive disorder within the last year. Two scores were derived from the SELFPASS item pool: SELFPASS depression (SP-D) and SELFPASS anxiety (SP-A). Reliability was examined using Cronbach α. Construct validity was assessed through Pearson correlations with the Patient Health Questionnaire-9 (PHQ-9), the General Anxiety Disorder Scale-7 (GAD-7), and the WHO-5-Wellbeing-Scale (WHO-5). Logistic regression analysis was performed as an indicator for concurrent criterion validity of SP-D and SP-A. Factor analysis was performed to provide information about the underlying factor structure of the item pool. Item-scale correlations were calculated in order to determine item quality. ResultsA total of 284 participants were included, with 192 (67.6%) healthy subjects and 92 (32.4%) patients. Cronbach α was set to .94 for SP-D and α=.88 for SP-A. We found significant positive correlations between SP-D and PHQ-9 scores (r=0.87; P<.001) and between SP-A and GAD-7 scores (r=0.80; P<.001), and negative correlations between SP-D and WHO-5 scores (r=–0.80; P<.001) and between SP-A and WHO-5 scores (r=–0.69; P<.001). Increasing scores of SP-D and SP-A led to increased odds of belonging to the patient group (SP-D: odds ratio 1.03, 95% CI 1.01-1.05; P<.001; SP-A: 1.05, 1.05-1.01; P=.01). The item pool yielded 2 factors: one that consisted of mood-related items and another with somatic-related items. ConclusionsThe SELFPASS item pool showed good psychometric properties in terms of reliability, construct, and criterion validity. The item pool is an appropriate source for daily mood tracking in future e-mental health apps among patients with depression. Our study provides general recommendations for future developments as well as recommendations within the item pool

Experiences of Patients and Therapists Testing a Virtual Reality Exposure App for Symptoms of Claustrophobia: Mixed Methods Study

BackgroundThe effectiveness of virtual reality exposure (VRE) in the treatment of anxiety disorders is well established. Several psychological mechanisms of VRE have been identified, whereby both emotional processing and the sense of presence play a key role. However, there are only few studies that contribute to our knowledge of examples of implementation in the case of VRE for claustrophobia based on patients' experiences and the perspective of therapists. ObjectiveThis study asks for key elements of a VRE app that are necessary for effective exposure for people with claustrophobic symptoms. MethodsA mixed methods design was applied in which patients (n=15) and therapeutic experts (n=15) tested a VRE intervention of an elevator ride at 5 intensity levels. Intensity was varied by elevator size, duration of the elevator ride, and presence of virtual humans. Quantitative measures examined self-reported presence with the Igroup Presence Questionnaire (IPQ) ranging from 0 to 6 and 15 Likert-scaled evaluation items that had been developed for the purpose of this study, ranging from 1 to 5. In both measures, higher scores indicate higher levels of presence or agreement. Think-aloud protocols of the patients and semistructured interviews posttreatment of all participants were conducted to gain in-depth perspectives on emotional processes. ResultsThe intervention induced a feeling of presence in patients and experts, posttreatment scores showed a high IPQ presence score (mean 3.84, SD 0.88), with its subscores IPQ spatial presence (mean 4.53, SD 1.06), IPQ involvement (mean 3.83, SD 1.22), and IPQ experienced realism (mean 2.75, SD 1.02). Patients preferred a setting in the presence of a therapist (mean 4.13, SD 0.83) more than the experts did (mean 3.33, SD 1.54). Think-aloud protocols of the patients revealed that presence and anxiety both were achieved. Qualitative interviews of patients and experts uncovered 8 topics: feelings and emotions, personal story, telepresence, potential therapeutic effects, barriers, conditions and requirements, future prospects, and realization. The intensity levels were felt to appropriately increase in challenge, with ambivalent results regarding the final level. Virtual humans contributed to feelings of fear. ConclusionsKey elements of a VRE app for claustrophobic symptoms should include variation of intensity by adding challenging cues in order to evoke presence and anxiety. Virtual humans are a suitable possibility to make the intervention realistic and to provide a sense of closeness; however, some of the fears might then be related to symptoms of social phobia or agoraphobia. Patients may need the physical presence of a therapist, though not all of them share this view. A higher degree of sophistication in the intensity levels is needed to deliver targeted help for specific symptoms of anxiety

Barriers to access cancer‐related services for men in high‐income countries: A narrative review looking beyond socioeconomic disadvantages

Abstract Introduction Cancer screening programs are routinely available in high‐income countries, but participation rates are low, especially among men. This narrative review aims to identify male‐specific access barriers to cancer‐related healthcare in high‐income countries that offer statutory insurance/subsidized health care. Methods We searched PubMed, Science Direct, and Web of Science for peer‐reviewed journal articles published within the past 10 years on cancer healthcare access, help‐seeking behavior, and men. Step‐wise screening of title, abstract, and full text resulted in 23 studies that fit the selection criteria for findings in high‐income countries. The results were analyzed descriptively using qualitative thematic synthesis. Results In the reviewed studies, barriers for men in accessing cancer‐related healthcare offers could be broadly categorized under sociocultural norms, personal behaviors, and structural problems. The most common barriers were related to sociocultural influences and included notions of masculinity, distrust in the medical system, and personnel/social commitments. Major personal barriers included fear of getting cancer or screening methods, lack of awareness about cancer, and problems in communication with healthcare professionals. Accessibility and lack of insurance were reported as common structural barriers. Conclusions The reluctance of men in approaching medical help was rooted in sociocultural norms of traditional masculinity with direct and indirect consequences such as fear, lack of awareness, distrust of medical personnel, and problems in communicating with healthcare professionals. Gender‐specific, male‐oriented information via digital, anonymous interventions may be helpful for increasing participation of men in cancer care

Sexual Orientation and Gender Identity Data Collection in Oncology Practice: Findings of an ASCO Survey

PURPOSE: Lack of collection of sexual orientation and gender identity (SOGI) data in oncology practices limits assessment of sexual and gender minority (SGM) cancer patients\u27 experiences and restricts opportunities to improve health outcomes of SGM patients. Despite national calls for routine SOGI data collection, individual-level and institutional barriers hinder progress. This study aimed to identify these barriers in oncology. METHODS: An online survey of ASCO members and others assessed SOGI data collection in oncology practices, institutional characteristics related to SOGI data collection, respondents\u27 attitudes about SOGI data and SGM patients, and respondent demographics. Logistic regression calculated adjusted odds ratios (ORs) and 95% CIs for factors associated with sexual orientation (SO) and gender identity (GI) data collection. RESULTS: Less than half of 257 respondents reported institutional SO and GI data collection (40% and 46%, respectively), whereas over a third reported no institutional data collection (34% and 32%, respectively) and the remainder were unsure (21% and 17%, respectively). Most respondents felt that knowing both SO and GI was important for quality care (77% and 85%, respectively). Collection of SO and GI was significantly associated in separate models with leadership support (ORs = 8.01 and 6.02, respectively), having resources for SOGI data collection (ORs = 10.6 and 18.7, respectively), and respondents\u27 belief that knowing patient SO and GI is important (ORs = 4.28 and 2.76, respectively). Themes from qualitative comments mirrored the key factors identified in our quantitative analysis. CONCLUSION: Three self-reinforcing factors emerged as critical drivers for collecting SOGI data: leadership support, dedicated resources, and individual respondents\u27 attitudes. Policy mandates, implementation science, and clinical reimbursement are strategies to advance meaningful data collection and use in clinical practice