Empowerment or Engagement? Digital Health Technologies for Mental Healthcare

We argue that while digital health technologies (e.g. artificial intelligence, smartphones, and virtual reality) present significant opportunities for improving the delivery of healthcare, key concepts that are used to evaluate and understand their impact can obscure significant ethical issues related to patient engagement and experience. Specifically, we focus on the concept of empowerment and ask whether it is adequate for addressing some significant ethical concerns that relate to digital health technologies for mental healthcare. We frame these concerns using five key ethical principles for AI ethics (i.e. autonomy, beneficence, non-maleficence, justice, and explicability), which have their roots in the bioethical literature, in order to critically evaluate the role that digital health technologies will have in the future of digital healthcare

Presence and rehabilitation: toward second-generation virtual reality applications in neuropsychology

Virtual Reality (VR) offers a blend of attractive attributes for rehabilitation. The most exploited is its ability to create a 3D simulation of reality that can be explored by patients under the supervision of a therapist. In fact, VR can be defined as an advanced communication interface based on interactive 3D visualization, able to collect and integrate different inputs and data sets in a single real-like experience. However, "treatment is not just fixing what is broken; it is nurturing what is best" (Seligman & Csikszentmihalyi). For rehabilitators, this statement supports the growing interest in the influence of positive psychological state on objective health care outcomes. This paper introduces a bio-cultural theory of presence linking the state of optimal experience defined as "flow" to a virtual reality experience. This suggests the possibility of using VR for a new breed of rehabilitative applications focused on a strategy defined as transformation of flow. In this view, VR can be used to trigger a broad empowerment process within the flow experience induced by a high sense of presence. The link between its experiential and simulative capabilities may transform VR into the ultimate rehabilitative device. Nevertheless, further research is required to explore more in depth the link between cognitive processes, motor activities, presence and flow

A survey of eMedia-delivered interventions for schizophrenia used in randomized controlled trials

Background: Randomized trials evaluating electronic Media (eMedia) delivery of interventions are increasingly frequent in mental health. Although a number of reviews have reported efficacy of these interventions, none has reviewed the type of eMedia interventions and quality of their description. We therefore decided to conduct a survey of eMedia-delivered interventions for schizophrenia. Methods: We surveyed all relevant trials reliably identified in the Cochrane Schizophrenia Group’s comprehensive register of trials by authors working independently. Data were extracted regarding the size of the trial, interventions, outcomes and how well the intervention was described. Results: eMedia delivery of interventions is increasingly frequent in trials relevant to the care of people with schizophrenia. The trials varied considerably in sample sizes (mean =123, median =87, range =20–507), and interventions were diverse, rarely evaluating the same approaches and were poorly reported. This makes replication impossible. Outcomes in these studies are limited, have not been noted to be chosen by end users and seem unlikely to be easy to apply in routine care. No study reported on potential adverse effects or cost, end users satisfaction or ease of use. None of the papers mentioned the use of CONSORT eHealth guidelines. Conclusion: There is a need to improve reporting and testing of psychosocial interventions delivered by eMedia. New trials should comply with CONSORT eHealth guidance on design, conduct and reporting, and existing CONSORT should be updated regularly, as the field is constantly evolving

Development and Content Validation of Scoresheet and User Manual to Assess the Quality of Health Apps

There has been a continuous growth of health application programs (apps) both in web-based and mobile platforms in recent years. However, there has been no instrument available to assess the degree of quality of these apps in Finland during the time this study has been initiated. The aim of this study was to develop an easy-to-use and practical scoresheet and user manual to assess the degree of quality of health apps as well as validate its contents using an expert panel. The design of the study adopted a two-stage process. The first stage entails designing the instrument in which the identification of conceptual framework, item generation and determining the structure of the instrument were performed. A comprehensive literature review was undertaken as well as the examination of applicable legislations, policies and guidelines pertaining to mHealth and digital health devices. The second stage entailed judgement wherein the scoresheet was tested for face validity with a small representative sample (n=6) of intended users and two rounds of content validation using an expert panel (n=19). The Content Validity Index (CVI) both in item and scale-levels were computed. The result of the study yielded a total of 34 content validated items categorized into five distinctive domains – Basic Details, Health Content, Technical Properties, User-orientation, Privacy and Safety. The CVIs on item-level for all items reached a favorable score of > 0,78 on the assertions of relevance and clarity. Whilst it garnered > 0,90 on scale level based on universal agreement and average. This study paved ways for the scoresheet and user manual to proceed with further psychometric measurement procedures such as reliability, feasibility and acceptability.Terveydenhuollon ei-lääkinnällisten sovellusten (apps) määrä on kasvanut jatkuvasti viime vuosina sekä verkko- että mobiilialustoilla. Tämän tutkimuksen aloittamisen aikana ei Suomessa kuitenkaan ollut saatavilla instrumenttia näiden sovellusten laadun arvioimiseksi. Tämän tutkimuksen tarkoituksena oli kehittää helppokäyttöinen ja käytännöllinen mittari ja käyttöopas terveyssovellusten laadun arvioimiseksi ja validoida sen sisältö asiantuntijapaneelin avulla. Tutkimus toteutettiin kaksivaiheisena. Ensimmäisessä vaiheessa kehitettiin mittari eli määritettiin teoreettinen viitekehys, ja muodostettiin sen perusteella mittarin osiot ja rakenne. Vaiheessa yksi toteutettiin kattava kirjallisuuskatsaus sekä koottiin yhteen terveyssovelluksia koskeva lainsäädäntö ja viralliset ohjeistukset. Tutkimuksen toisessa vaiheessa arvioitiin kehitetyn mittarin ilmivaliditeettia (face validity) tavoiteltua käyttäjäjoukkoa edustavalla tarkoituksenmukaisella otoksella (n=6). Sisältövaliditeetin (content validity) testaamiseen rekrytoitiin asiantuntijapaneeli (n=19) ja he toteuttivat mittarille kaksi validointikierrosta. Vastauksista laskettiin Content Validity Index (CVI) sekä osioiden että mittarin tasolla (item and scale levels). Tutkimuksen tuloksena syntyi 34 kohdan asiantuntijapaneelin validoima mittari terveyssovellusten laadun arvioimiseen. Mittarin kohdat on luokiteltu aihealueittain viiteen osa-alueeseen: perustiedot, terveyteen liittyvä sisältö, tekniset ominaisuudet, käyttäjälähtöisyys, sekä yksityisyys ja turvallisuus. Kaikkien osioiden CVI pisteet saavuttivat suotuisat lukemat > 0,78 relevanssiuden ja selkeyden osalta. Lisäksi mittari sai > 0,90 pisteet koko mittarin tasolla (universal agreement and average). Tämä tutkimus tuotti uuden tavan arvioida terveyssovellusten laatua. Jatkossa mittarin ja sen käyttöoppaan psykometrisiä ominaisuuksia kuten reliabiliteettia sekä käyttökelpoisuutta ja hyväksyttävyyttä tulee edelleen testata

Wearables at work:preferences from an employee’s perspective

This exploratory study aims to obtain a first impression of the wishes and needs of employees on the use of wearables at work for health promotion. 76 employ-ees with a mean age of 40 years old (SD ±11.7) filled in a survey after trying out a wearable. Most employees see the potential of using wearable devices for workplace health promotion. However, according to employees, some negative aspects should be overcome before wearables can effectively contribute to health promotion. The most mentioned negative aspects were poor visualization and un-pleasantness of wearing. Specifically for the workplace, employees were con-cerned about the privacy of data collection

Digital tools for direct assessment of autism risk during early childhood: A systematic review

Current challenges in early identification of autism spectrum disorder lead to significant delays in starting interventions, thereby compromising outcomes. Digital tools can potentially address this barrier as they are accessible, can measure autism-relevant phenotypes and can be administered in children’s natural environments by non-specialists. The purpose of this systematic review is to identify and characterise potentially scalable digital tools for direct assessment of autism spectrum disorder risk in early childhood. In total, 51,953 titles, 6884 abstracts and 567 full-text articles from four databases were screened using predefined criteria. Of these, 38 met inclusion criteria. Tasks are presented on both portable and non-portable technologies, typically by researchers in laboratory or clinic settings. Gamified tasks, virtual-reality platforms and automated analysis of video or audio recordings of children’s behaviours and speech are used to assess autism spectrum disorder risk. Tasks tapping social communication/interaction and motor domains most reliably discriminate between autism spectrum disorder and typically developing groups. Digital tools employing objective data collection and analysis methods hold immense potential for early identification of autism spectrum disorder risk. Next steps should be to further validate these tools, evaluate their generalisability outside laboratory or clinic settings, and standardise derived measures across tasks. Furthermore, stakeholders from underserved communities should be involved in the research and development process