Smartphone Intervention Research Articles

Trajectory of problematic smartphone use among adolescents aged 10-18 years: The roles of childhood family environment and concurrent parent-child relationships.

Background and aimsAdolescence is a period of high incidence of problematic smartphone use. Understanding the developmental trajectory of problematic smartphone use in adolescence and its influencing factors could guide the choice of timing for prevention and intervention. This study fitted the growth trajectory of problematic smartphone use among adolescents and examined its associations with the childhood family environment and concurrent parent–child relationships.MethodsUsing a cohort sequential design, we investigated 2,548 Chinese adolescents and their parents three times in three years. Multiple group multiple cohort growth models were used to fit the growth trajectory.ResultsThe quadratic growth trajectory of problematic smartphone use in adolescents aged 10–18 years showed a clear increasing trend, with a possible decreasing trend in late adolescence or early adulthood. Early life socioeconomic status, childhood family unpredictability, and the concurrent parent–child relationship had unique impacts on the development of problematic smartphone use during adolescence.Discussion and conclusionsEarly adolescence is a favorable time for problematic smartphone use prevention and intervention. A supportive family environment should be maintained throughout the different developmental stages of children and adolescents.

The Effectiveness of a Brief Telehealth and Smartphone Intervention for College Students Receiving Traditional Therapy: Longitudinal Study Using Ecological Momentary Assessment Data.

BackgroundBrief interventions such as mental health apps and single-session interventions are increasingly popular, efficacious, and accessible delivery formats that may be beneficial for college students whose mental health needs may not be adequately met by college counseling centers. However, no studies so far have examined the effectiveness of these modes of treatment for college students who are already receiving traditional therapy, despite it being common among this population.ObjectiveThe aim of this study was to compare the differences in self-reported momentary negative affect between college students in therapy and not in therapy who received a brief single-session intervention delivered by counseling center staff and a supplemental mobile app.MethodsData for this study were drawn from E-Manage, a brief mobile health intervention geared toward college students. Participants in the study were 173 college students who indicated whether they had received therapy. We conducted a multilevel model to determine whether there were differences between those in therapy versus not in therapy in negative affect reported throughout the study. Following this, we conducted multilevel models with therapy status as the predictor and negative affect as the outcome.ResultsResults of the multilevel model testing showed that the cross-level interaction between the time point (ie, pre- vs postexercise) and therapy status was significant (P=.008), with the reduction in negative affect from pre- to postexercise greater for those in therapy (b=–0.65, 95% CI –0.91 to –0.40; P<.001) than it was for those not in therapy (b=–0.31, 95% CI –0.43 to –0.19; P<.001). Therapy status was unassociated with both the pre-exercise (b=–1.69, 95% CI –3.51 to 0.13; P=.07) and postexercise (b=–1.37, 95% CI –3.17 to 0.43; P=.14) ratings of negative affect.ConclusionsThese findings suggest that app-based and single-session interventions are also appropriate to use among college students who are receiving traditional therapy. A randomized controlled trial comparing students receiving therapy to students receiving therapy and E-Manage will be necessary to determine to what extent E-Manage contributed to the reductions in negative affect that therapy-attending college students experienced.

Effect of Smartphone Assisted Cardiac Rehabilitation Self-Management (SACRSM) on Talk Test Value and Six Minute Walk Test Distance in Uncomplicated Cardio Vascular Disease (CVD) Patient – Single Case Study

Purpose: A single case study was carried to analyze the use of Smartphone Assisted Rehabilitation for Cardiac Patients through Self Management (SACRSM) on Talk Test value and 6MWTD in Uncomplicated Cardio Vascular Disease Patients. Design/Methodology/Approach: The researchers around the world have done various descriptive study designs to read the effect of Smartphone Assisted Cardiac Rehabilitation Self Management (SACRSM) on talk test and six minute walk test parameters which might help to attain the objectives of the study. Scarcity of literature on the effect of Smartphone Assisted Cardiac Rehabilitation Self-Management (SACRSM)to manage uncomplicated Cardio Vascular Disease patients on talk test value and six minute walk test parameters lead to undergo this study. Data were collected from the study are recorded and analyzed. The respondents of the study were uncomplicated cardio vascular disease patients within 6 months prior to this study intervention and who has been diagnosed and referred from Cardiac Physician. Finding/Result: This case study shown significant improvement in the outcome of talk test value and six minute walk test parameters with the effect of Smartphone Assisted Cardiac Rehabilitation Self Management (SACRSM) for 24 weeks in CVD patients. So SACRSM is important to be availed with easier feasible way to attain gain in the form of talk test value and six minute walk test parameters in coronary artery disease patients. Originality/Value: Execution of Cardiac Rehabilitation through Smartphone Intervention. Paper Type: Case Study Research

Effectiveness and cost-effectiveness for the treatment of depressive symptoms in refugees and asylum seekers: A multi-centred randomized controlled trial.

SummaryBackgroundCurrent evidence points towards a high prevalence of psychological distress in refugee populations, contrasting with a scarcity of resources and amplified by linguistic, institutional, financial, and cultural barriers. The objective of the study is to investigate the overall effectiveness and cost-effectiveness of a Stepped Care and Collaborative Model (SCCM) at reducing depressive symptoms in refugees, compared with the overall routine care practices within Germany's mental healthcare system (treatment-as-usual, TAU).MethodsA multicentre, clinician-blinded, randomised, controlled trial was conducted across seven university sites in Germany. Asylum seekers and refugees with relevant depressive symptoms with a Patient Health Questionnaires score of ≥ 5 and a Refugee Health Screener score of ≥ 12. Participants were randomly allocated to one of two treatment arms (SCCM or TAU) for an intervention period of three months between April 2018 and March 2020. In the SCCM, participants were allocated to interventions tailored to their symptom severity, including watchful waiting, peer-to-peer- or smartphone intervention, psychological group therapies or mental health expert treatment. The primary endpoint was defined as the change in depressive symptoms (Patient Health Questionnaire-9, PHQ-9) after 12 weeks. The secondary outcome was the change in Montgomery Åsberg Depression Rating Scale (MADRS) from baseline to post-intervention.FindingsThe intention-to-treat sample included 584 participants who were randomized to the SCCM (n= 294) or TAU (n=290). Using a mixed-effects general linear model with time, and the interaction of time by randomisation group as fixed effects and study site as random effect, we found significant effects for time (p < .001) and time by group interaction (p < .05) for intention-to-treat and per-protocol analysis. Estimated marginal means of the PHQ-9 scores after 12 weeks were significantly lower in SCCM than in TAU (for intention-to-treat: PHQ-9 mean difference at T1 1.30, 95% CI 1.12 to 1.48, p < .001; Cohen's d=.23; baseline-adjusted PHQ-9 mean difference at T1 0.57, 95% CI 0.40 to 0.74, p < .001). Cost-effectiveness and net monetary benefit analyses provided evidence of cost-effectiveness for the primary outcome and quality-adjusted life years. Robustness of results were confirmed by sensitivity analyses.InterpretationThe SSCM resulted in a more effective and cost-effective reduction of depressive symptoms compared with TAU. Findings suggest a suitable model to provide mental health services in circumstances where resources are limited, particularly in the context of forced migration and pandemics.FundingThis project is funded by the Innovationsfond and German Ministry of Health [grant number 01VSF16061]. The present trial is registered under Clinical-Trials.gov under the registration number: NCT03109028. https://clinicaltrials.gov/ct2/show/NCT03109028

The Internet Based Intervention and Digital Technology Use for Improving Medication Adherence of Patients with Schizophrenia or Another Mental Illness: a Systematic Review

A growing body of literature sheds light on internet based interventions and digital technology use in mental illness. The purpose of this study is to provide an overview of internet based interventions and digital technology use in patients with schizophrenia or mental illness and their documented outcomes of the medication adherence and relapse prevention. Methods : Databases searched for this systhematic review were Scopus, CINAHL, Science Direct, Sage, and Pubmed at the time of publication between 2016 and 2021 which was limited by journal source type. The search terms, truncated when relevant, were ("schizophrenia" OR psychosis OR "mental illness") AND (“internet based intervention” OR “online intervention” OR “mobile health” OR telemedicine OR telehealth”) AND (“medication adherence” OR “medication compliance”). Eleven peer reviewed intervention studies targeting adults with schizophrenia or another mental illness were reviewed and analyzed. The Joanna Briggs Institute Guideline was used for critical appraisal. Results : There are eight categories of interventions emerged: telephone intervention, video conference, mobile texting, texting combined telephone, smartphone intervention, texting combined smartphone intervention, web based intervention, and WeChat based intervention. Conclusions : Most of the previous literatures stated that there were significant effects of internet based intervention and digital technology use for improving medical adherence of patients with schizophrenia or another mental illness.

A smartphone application of “Family Connections” to increase the use of skills and improve psychological symptoms in relatives of people with borderline personality disorder: A study protocol for a randomized controlled trial

BackgroundThe literature reveals that borderline personality disorder (BPD) is an important public mental health problem that affects both the patients and their families. Moreover, studies indicate a high prevalence of psychological symptoms and burden in relatives of people with BPD. Therefore, it is necessary to develop useful and accessible interventions specifically addressed to the caregivers. Smartphone interventions with Ecological Momentary Assessment (EMA) and Ecological Momentary Interventions (EMI) offer several potential advantages in this regard. The aims of our study are to test the effectiveness of a combined intervention supported by a smartphone app versus the same intervention supported by a paper-based manual, studying the feasibility and acceptance of both conditions and evaluating the perceptions and opinions of families about both interventions. This paper contains the study protocol. MethodThe design of this study protocol is a randomized controlled trial. A minimum of 116 relatives will be randomly assigned to two conditions: Treatment as usual (TAU) (N = 58) or Treatment as usual + EMI (TAU+EMI) (N = 58), with TAU being the Family Connection program. The primary outcome will be the Burden Assessment Scale. Secondary outcomes will include psychological symptoms, mastery and empowerment, and resilience. Outcomes will be assessed from pre-treatment to post-treatment (3 months). Statistical analyses will be performed using Student's t-tests, mixed models (ANCOVA) and intention-to-treat analysis. DiscussionThe results of this study will provide a basis for future EMA- and EMI-based application interventions for family members of people with BPD and family members of people with other mental disorders who could benefit from the skills taught.

Digital smartphone intervention to recognise and manage early warning signs in schizophrenia to prevent relapse: the EMPOWER feasibility cluster RCT.

Relapse is a major determinant of outcome for people with a diagnosis of schizophrenia. Early warning signs frequently precede relapse. A recent Cochrane Review found low-quality evidence to suggest a positive effect of early warning signs interventions on hospitalisation and relapse. How feasible is a study to investigate the clinical effectiveness and cost-effectiveness of a digital intervention to recognise and promptly manage early warning signs of relapse in schizophrenia with the aim of preventing relapse? A multicentre, two-arm, parallel-group cluster randomised controlled trial involving eight community mental health services, with 12-month follow-up. Glasgow, UK, and Melbourne, Australia. Service users were aged > 16 years and had a schizophrenia spectrum disorder with evidence of a relapse within the previous 2 years. Carers were eligible for inclusion if they were nominated by an eligible service user. The Early signs Monitoring to Prevent relapse in psychosis and prOmote Wellbeing, Engagement, and Recovery (EMPOWER) intervention was designed to enable participants to monitor changes in their well-being daily using a mobile phone, blended with peer support. Clinical triage of changes in well-being that were suggestive of early signs of relapse was enabled through an algorithm that triggered a check-in prompt that informed a relapse prevention pathway, if warranted. The main outcomes were feasibility of the trial and feasibility, acceptability and usability of the intervention, as well as safety and performance. Candidate co-primary outcomes were relapse and fear of relapse. We recruited 86 service users, of whom 73 were randomised (42 to EMPOWER and 31 to treatment as usual). Primary outcome data were collected for 84% of participants at 12 months. Feasibility data for people using the smartphone application (app) suggested that the app was easy to use and had a positive impact on motivations and intentions in relation to mental health. Actual app usage was high, with 91% of users who completed the baseline period meeting our a priori criterion of acceptable engagement (> 33%). The median time to discontinuation of > 33% app usage was 32 weeks (95% confidence interval 14 weeks to ∞). There were 8 out of 33 (24%) relapses in the EMPOWER arm and 13 out of 28 (46%) in the treatment-as-usual arm. Fewer participants in the EMPOWER arm had a relapse (relative risk 0.50, 95% confidence interval 0.26 to 0.98), and time to first relapse (hazard ratio 0.32, 95% confidence interval 0.14 to 0.74) was longer in the EMPOWER arm than in the treatment-as-usual group. At 12 months, EMPOWER participants were less fearful of having a relapse than those in the treatment-as-usual arm (mean difference -4.29, 95% confidence interval -7.29 to -1.28). EMPOWER was more costly and more effective, resulting in an incremental cost-effectiveness ratio of £3041. This incremental cost-effectiveness ratio would be considered cost-effective when using the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year gained. This was a feasibility study and the outcomes detected cannot be taken as evidence of efficacy or effectiveness. A trial of digital technology to monitor early warning signs that blended with peer support and clinical triage to detect and prevent relapse is feasible. A main trial with a sample size of 500 (assuming 90% power and 20% dropout) would detect a clinically meaningful reduction in relapse (relative risk 0.7) and improvement in other variables (effect sizes 0.3-0.4). This trial is registered as ISRCTN99559262. This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 27. See the NIHR Journals Library website for further project information. Funding in Australia was provided by the National Health and Medical Research Council (APP1095879).

Increasing the Effectiveness of a Physical Activity Smartphone Intervention With Positive Suggestions: Randomized Controlled Trial.

BackgroundeHealth interventions have the potential to increase the physical activity of users. However, their effectiveness varies, and they often have only short-term effects. A possible way of enhancing their effectiveness is to increase the positive outcome expectations of users by giving them positive suggestions regarding the effectiveness of the intervention. It has been shown that when individuals have positive expectations regarding various types of interventions, they tend to benefit from these interventions more.ObjectiveThe main objective of this web-based study is to investigate whether positive suggestions can change the expectations of participants regarding the effectiveness of a smartphone physical activity intervention and subsequently enhance the number of steps the participants take during the intervention. In addition, we study whether suggestions affect perceived app effectiveness, engagement with the app, self-reported vitality, and fatigue of the participants.MethodsThis study involved a 21-day fully automated physical activity intervention aimed at helping participants to walk more steps. The intervention was delivered via a smartphone-based app that delivered specific tasks to participants (eg, setting activity goals or looking for social support) and recorded their daily step count. Participants were randomized to either a positive suggestions group (69/133, 51.9%) or a control group (64/133, 48.1%). Positive suggestions emphasizing the effectiveness of the intervention were implemented in a web-based flyer sent to the participants before the intervention. Suggestions were repeated on days 8 and 15 of the intervention via the app.ResultsParticipants significantly increased their daily step count from baseline compared with 21 days of the intervention (t107=−8.62; P<.001) regardless of the suggestions. Participants in the positive suggestions group had more positive expectations regarding the app (B=−1.61, SE 0.47; P<.001) and higher expected engagement with the app (B=3.80, SE 0.63; P<.001) than the participants in the control group. No effects of suggestions on the step count (B=−22.05, SE 334.90; P=.95), perceived effectiveness of the app (B=0.78, SE 0.69; P=.26), engagement with the app (B=0.78, SE 0.75; P=.29), and vitality (B=0.01, SE 0.11; P=.95) were found. Positive suggestions decreased the fatigue of the participants during the 3 weeks of the intervention (B=0.11, SE 0.02; P<.001).ConclusionsAlthough the suggestions did not affect the number of daily steps, they increased the positive expectations of the participants and decreased their fatigue. These results indicate that adding positive suggestions to eHealth physical activity interventions might be a promising way of influencing subjective but not objective outcomes of interventions. Future research should focus on finding ways of strengthening the suggestions, as they have the potential to boost the effectiveness of eHealth interventions.Trial RegistrationOpen Science Framework 10.17605/OSF.IO/CWJES; https://osf.io/cwjes

A Systematic Review of Smartphone and Tablet Use by Older Adults With and Without Cognitive Impairment.

Background and ObjectivesA systematic review was conducted to explore the use of smartphones and tablet computers as cognitive and memory aids by older adults with and without cognitive impairment, specifically the effects of smartphone and tablet use on participants’ cognition and memory, and the barriers and facilitators to smartphone and tablet use for cognitive and memory support.Research Design and MethodsA systematic search of 6 key databases found 11,895 citations published between 2010 and 2021. Studies were included if they involved community-dwelling older adults with or without cognitive impairment arising from acquired brain injury, mild cognitive impairment, or dementia, and if they evaluated everyday smartphone or tablet device use for cognition, memory, or activities of daily living.ResultsA total of 28 papers were included in the narrative synthesis. There was some evidence that the use of smartphones and tablets could aid cognitive function in older adults without cognitive impairment, particularly executive function and processing speed. There was modest evidence that smartphone and tablet use could support memory in both older adults without cognitive impairment and those with acquired brain injury and dementia.Discussion and ImplicationsSmartphones and tablets were seen by users as acceptable, enjoyable, and nonstigmatizing alternatives to conventional assistive technology devices; however, current use of smartphone and tablet devices is hindered by the digital literacy of older adults, a lack of accommodation for older adult users’ motor and sensory impairments, and a lack of input from clinicians and researchers. Much of the evidence presented in this review derives from case studies and small-scale trials of smartphone and tablet training interventions. Further research is needed into older adults’ use of smartphones and tablets for cognitive support before and after the onset of cognitive impairment in order to develop effective evidence-based smart technology cognition and memory aids.

Mobile technology access and use among youth in Nairobi, Kenya: implications for mobile health intervention design.

Social media can be used to support the health of underserved youth beyond clinical settings. Young people are avid users of social media, but estimates of smartphone access among youth in sub-Saharan Africa are lacking, making it difficult to determine context-appropriateness of online and social media interventions. We conducted a cross-sectional observational survey assessing technology access and use among youth aged 14-24 receiving general outpatient or human immunodeficiency virus (HIV) care in three hospitals in Nairobi, Kenya. Correlates of smartphone access and social media use were evaluated by Poisson regression. Of 600 youth, 301 were receiving general outpatient care and 299 HIV care. Median age was 18 years. Overall, 416 (69%) had access to a mobile phone and 288 (48%) to a smartphone. Of those with smartphones, 260 (90%) used social media. Smartphone access varied by facility (40% at the sub-county hospital vs. 55% at the national referral hospital, P=0.004) and was associated with older age [65% in 20-24-year-old vs. 37% in 14-19-year-old, adjusted prevalence ratio (aPR) 1.58, 95% CI: 1.30-1.92], secondary vs. primary education (aPR 2.59, 95% CI: 1.76-3.81), and HIV vs. general outpatient care (aPR 1.18, 95% CI: 1.01-1.38). Social media use was similarly associated with facility, older age, higher education, and male gender. These data suggest that smartphone-based and social media interventions are accessible in Nairobi, Kenya, in the general population and youth living with HIV, and most appropriate for older youth. Intervention developers and policymakers should consider smartphone and social media interventions as candidates for youth health programs, while noting that heterogeneity of access between and within communities requires tailoring to the specific intervention context to avoid excluding the most vulnerable youth.

Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials.

Mobile phone-based interventions have been proposed as a means for reducing the burden of disease associated with mental illness. While numerous randomized controlled trials and meta-analyses have investigated this possibility, evidence remains unclear. We conducted a systematic meta-review of meta-analyses examining mobile phone-based interventions tested in randomized controlled trials. We synthesized results from 14 meta-analyses representing 145 randomized controlled trials and 47,940 participants. We identified 34 effect sizes representing unique pairings of participants, intervention, comparisons, and outcome (PICO) and graded the strength of the evidence as using umbrella review methodology. We failed to find convincing evidence of efficacy (i.e., n > 1000, p < 10−6, I2 < 50%, absence of publication bias); publication bias was rarely assessed for the representative effect sizes. Eight effect sizes provided highly suggestive evidence (i.e., n > 1000, p < 10−6), including smartphone interventions outperforming inactive controls on measures of psychological symptoms and quality of life (ds = 0.32 to 0.47) and text message-based interventions outperforming non-specific controls and active controls for smoking cessation (ds = 0.31 and 0.19, respectively). The magnitude of effects and strength of evidence tended to diminish as comparison conditions became more rigorous (i.e., inactive to active, non-specific to specific). Four effect sizes provided suggestive evidence, 14 effect sizes provided weak evidence, and eight effect sizes were non-significant. Despite substantial heterogeneity, no moderators were identified. Adverse effects were not reported. Taken together, results support the potential of mobile phone-based interventions and highlight key directions to guide providers, policy makers, clinical trialists, and meta-analysts working in this area.

Recruiting Older Adults With Cognitive Impairments for a Smartphone Intervention During COVID-19

The Coronavirus disease 2019 (COVID-19) pandemic has introduced numerous challenges to the global scientific community and has been particularly disruptive to the conduct of ongoing clinical trials. Gerontological studies that focus on older adults with cognitive impairments have endured additional challenges ranging from increased vulnerability of this group to COVID-19, thereby prohibiting study participation, to difficulties in participant engagement as a product of a worsening Digital Divide. The purpose of this talk is to describe the pandemic-related factors that have influenced recruitment and enrollment of older adults with mild cognitive impairment and mild dementia in an ongoing feasibility study of a physical activity smartphone app. We discuss the changes we made to recruitment procedures and the impact those changes have had on the success of enrolling individuals in the study. We conclude with a discussion of feasible strategies and procedural alterations moving forward that may facilitate achievement of enrollment goals.

Association of In-Lab and Free-Living Mobility Measures With Falls and Fear of Falling in Underactive Older People

Falls in older adults have significant consequences—a single fall can lead to serious injury, psychological trauma, activity restriction, and increased mortality. This study describes differences in mobility-related characteristics of underactive (<150 minutes/week of physical activity), racially diverse, older adults (65–84 years) classified by self-reported fall status (0, 1, 2+ falls in previous 12mo) and fear of falling (yes/no). We analyzed baseline data from 105 individuals (mean age=72.1 years; 73% female; 64% white, 29% Black, 12% Asian) who participated in a trial of a physical activity smartphone intervention for older people. Total minutes of daily stepping and medium-to-brisk (≥75 steps/min) and brisk (≥100) cadence bouts in free-living conditions was gathered over 3 days via ActivPal activity monitor. Gait speed was determined from a 4-meter walk test for those pretested prior to COVID-19 mandates (n=60). Of the median 81.8 minutes spent stepping daily, very few minutes involved moderate-to-brisk (14.0) or brisk cadence (10.1). Groups classified by fall status (non-fallers n=74, 1x fallers n=18, repeat fallers n=13) differed significantly in daily minutes spent in medium-to-brisk (p=0.04) and brisk cadence (p=0.02), but not in 4-meter gait speed or total minutes stepping. Individuals who reported fear of falling versus those with no fear did not differ significantly on any mobility-related parameters. Four-meter gait speed was significantly negatively correlated with both cadence measures (p=0.02) but not total minutes stepping. This study indicates that faster walking behaviors in everyday activity may be a useful target for intervention to prevent falls in underactive older adults.

A Smartphone-Based Self-Management Intervention for Individuals with Bipolar Disorder (LiveWell): Qualitative Study on User Experiences of the Behavior Change Process.

BackgroundBipolar disorder is a severe mental illness characterized by recurrent episodes of depressed, elevated, and mixed mood states. The addition of psychotherapy to pharmacological management can decrease symptoms, lower relapse rates, and improve quality of life; however, access to psychotherapy is limited. Mental health technologies such as smartphone apps are being studied as a means to increase access to and enhance the effectiveness of adjunctive psychotherapies for bipolar disorder. Individuals with bipolar disorder find this intervention format acceptable, but our understanding of how people utilize and integrate these tools into their behavior change and maintenance processes remains limited.ObjectiveThe objective of this study was to explore how individuals with bipolar disorder perceive and utilize a smartphone intervention for health behavior change and maintenance.MethodsIndividuals with bipolar disorder were recruited via flyers placed at university-affiliated and private outpatient mental health practices to participate in a pilot study of LiveWell, a smartphone-based self-management intervention. At the end of the study, all participants completed in-depth qualitative exit interviews. The behavior change framework developed to organize the intervention design was used to deductively code behavioral targets and determinants involved in target engagement. Inductive coding was used to identify themes not captured by this framework.ResultsIn terms of behavioral targets, participants emphasized the importance of managing mood episode–related signs and symptoms. They also discussed the importance of maintaining regular routines, sleep duration, and medication adherence. Participants emphasized that receiving support from a coach as well as seeking and receiving assistance from family, friends, and providers were important for managing behavioral targets and staying well. In terms of determinants, participants stressed the important role of monitoring for their behavior change and maintenance efforts. Monitoring facilitated self-awareness and reflection, which was considered valuable for staying well. Some participants also felt that the intervention facilitated learning information necessary for managing bipolar disorder but others felt that the information provided was too basic.ConclusionsIn addition to addressing acceptability, satisfaction, and engagement, a person-based design of mental health technologies can be used to understand how people experience the impact of these technologies on their behavior change and maintenance efforts. This understanding may then be used to guide ongoing intervention development. The participants’ perceptions aligned with the intervention’s primary behavioral targets and use of a monitoring tool as a core intervention feature. Participant feedback further indicates that developing additional content and tools to address building and engaging social support may be an important avenue for improving LiveWell. A comprehensive behavior change framework to understand participant perceptions of their behavior change and maintenance efforts may help facilitate ongoing intervention development.

Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients

Surgical site infections (SSI) cause substantial morbidity and pose a burden to acute healthcare services after surgery. We aimed to investigate whether a smartphone-delivered wound assessment tool can expedite diagnosis and treatment of SSI after emergency abdominal surgery. This single-blinded randomised control trial (NCT02704897) enroled adult emergency abdominal surgery patients in two tertiary care hospitals. Patients were randomised (1:1) to routine postoperative care or additional access to a smartphone-delivered wound assessment tool for 30-days postoperatively. Patient-reported SSI symptoms and wound photographs were requested on postoperative days 3, 7, and 15. The primary outcome was time-to-diagnosis of SSI (Centers for Disease Control definition). 492 patients were randomised (smartphone intervention: 223; routine care: 269). There was no significant difference in the 30-day SSI rate between trial arms: 21 (9.4%) in smartphone vs 20 (7.4%, p = 0.513) in routine care. Among the smartphone group, 32.3% (n = 72) did not utilise the tool. There was no significant difference in time-to-diagnosis of SSI for patients receiving the intervention (−2.5 days, 95% CI: −6.6−1.6, p = 0.225). However, patients in the smartphone group had 3.7-times higher odds of diagnosis within 7 postoperative days (95% CI: 1.02−13.51, p = 0.043). The smartphone group had significantly reduced community care attendance (OR: 0.57, 95% CI: 0.34−0.94, p = 0.030), similar hospital attendance (OR: 0.76, 95% CI: 0.28−1.96, p = 0.577), and significantly better experiences in accessing care (OR: 2.02, 95% CI: 1.17−3.53, p = 0.013). Smartphone-delivered wound follow-up is feasible following emergency abdominal surgery. This can facilitate triage to the appropriate level of assessment required, allowing earlier postoperative diagnosis of SSI.

Evaluating the Efficacy of Automated Smoking Treatment for People With HIV: Protocol for a Randomized Controlled Trial.

BackgroundSmoking prevalence rates among people with HIV are nearly 3 times higher than those in the general population. Nevertheless, few smoking cessation trials targeting smokers with HIV have been reported in the literature. Efforts to develop and evaluate sustainable, low-cost, and evidence-based cessation interventions for people with HIV are needed. Given the widespread proliferation of mobile phones, the potential of using mobile health apps to improve the reach and efficacy of cessation interventions is promising, but evidence of efficacy is lacking, particularly among people with HIV.ObjectiveThis study will consist of a 2-group randomized controlled trial to evaluate a fully automated smartphone intervention for people with HIV seeking cessation treatment.MethodsParticipants (N=500) will be randomized to receive either standard treatment (ST; 250/500, 50%) or automated treatment (AT; 250/500, 50%). ST participants will be connected to the Florida Quitline and will receive nicotine replacement therapy in the form of transdermal patches and lozenges. This approach, referred to as Ask Advise Connect, was developed by our team and has been implemented in numerous health systems. ST will be compared with AT, a fully automated behavioral treatment approach. AT participants will receive nicotine replacement therapy and an interactive smartphone-based intervention that comprises individually tailored audiovisual and text content. The major goal is to determine whether AT performs better in terms of facilitating long-term smoking abstinence than the more resource-intensive ST approach. Our primary aim is to evaluate the efficacy of AT in facilitating smoking cessation among people with HIV. As a secondary aim, we will explore potential mediators and moderators and conduct economic evaluations to assess the cost and cost-effectiveness of AT compared with ST.ResultsThe intervention content has been developed and finalized. Recruitment and enrollment will begin in the fall of 2021.ConclusionsThere is a critical need for efficacious, cost-effective, and sustainable cessation treatments for people with HIV who smoke. The AT intervention was designed to help fill this need. If efficacy is established, the AT approach will be readily adoptable by HIV clinics and community-based organizations, and it will offer an efficient way to allocate limited public health resources to tobacco control interventions.Trial RegistrationClinicalTrials.gov NCT05014282; https://clinicaltrials.gov/ct2/show/NCT05014282International Registered Report Identifier (IRRID)PRR1-10.2196/33183

A Smartphone Intervention for People With Serious Mental Illness: Fully Remote Randomized Controlled Trial of CORE.

BackgroundPeople with serious mental illness (SMI) have significant unmet mental health needs. Development and testing of digital interventions that can alleviate the suffering of people with SMI is a public health priority.ObjectiveThe aim of this study is to conduct a fully remote randomized waitlist-controlled trial of CORE, a smartphone intervention that comprises daily exercises designed to promote reassessment of dysfunctional beliefs in multiple domains.MethodsIndividuals were recruited via the web using Google and Facebook advertisements. Enrolled participants were randomized into either active intervention or waitlist control groups. Participants completed the Beck Depression Inventory-Second Edition (BDI-II), Generalized Anxiety Disorder-7 (GAD-7), Hamilton Program for Schizophrenia Voices, Green Paranoid Thought Scale, Recovery Assessment Scale (RAS), Rosenberg Self-Esteem Scale (RSES), Friendship Scale, and Sheehan Disability Scale (SDS) at baseline (T1), 30-day (T2), and 60-day (T3) assessment points. Participants in the active group used CORE from T1 to T2, and participants in the waitlist group used CORE from T2 to T3. Both groups completed usability and accessibility measures after they concluded their intervention periods.ResultsOverall, 315 individuals from 45 states participated in this study. The sample comprised individuals with self-reported bipolar disorder (111/315, 35.2%), major depressive disorder (136/315, 43.2%), and schizophrenia or schizoaffective disorder (68/315, 21.6%) who displayed moderate to severe symptoms and disability levels at baseline. Participants rated CORE as highly usable and acceptable. Intent-to-treat analyses showed significant treatment×time interactions for the BDI-II (F1,313=13.38; P<.001), GAD-7 (F1,313=5.87; P=.01), RAS (F1,313=23.42; P<.001), RSES (F1,313=19.28; P<.001), and SDS (F1,313=10.73; P=.001). Large effects were observed for the BDI-II (d=0.58), RAS (d=0.61), and RSES (d=0.64); a moderate effect size was observed for the SDS (d=0.44), and a small effect size was observed for the GAD-7 (d=0.20). Similar changes in outcome measures were later observed in the waitlist control group participants following crossover after they received CORE (T2 to T3). Approximately 41.5% (64/154) of participants in the active group and 60.2% (97/161) of participants in the waitlist group were retained at T2, and 33.1% (51/154) of participants in the active group and 40.3% (65/161) of participants in the waitlist group were retained at T3.ConclusionsWe successfully recruited, screened, randomized, treated, and assessed a geographically dispersed sample of participants with SMI entirely via the web, demonstrating that fully remote clinical trials are feasible in this population; however, study retention remains challenging. CORE showed promise as a usable, acceptable, and effective tool for reducing the severity of psychiatric symptoms and disability while improving recovery and self-esteem. Rapid adoption and real-world dissemination of evidence-based mobile health interventions such as CORE are needed if we are to shorten the science-to-service gap and address the significant unmet mental health needs of people with SMI during the COVID-19 pandemic and beyond.Trial RegistrationClinicalTrials.gov NCT04068467; https://clinicaltrials.gov/ct2/show/NCT04068467

Mechanisms of Smartphone Apps for Cigarette Smoking Cessation: Results of a Serial Mediation Model From the iCanQuit Randomized Trial.

BackgroundEngagement with digital interventions is a well-known predictor of treatment outcomes, but this knowledge has had limited actionable value. Instead, learning why engagement with digital interventions impact treatment outcomes can lead to targeted improvements in their efficacy.ObjectiveThis study aimed to test a serial mediation model of an Acceptance and Commitment Therapy (ACT) smartphone intervention for smoking cessation.MethodsIn this randomized controlled trial, participants (N=2415) from 50 US states were assigned to the ACT-based smartphone intervention (iCanQuit) or comparison smartphone intervention (QuitGuide). Their engagement with the apps (primary measure: number of logins) was measured during the first 3 months, ACT processes were measured at baseline and 3 months (acceptance of internal cues to smoke, valued living), and smoking cessation was measured at 12 months with 87% follow-up retention.ResultsThere was a significant serial mediation effect of iCanQuit on smoking cessation through multiple indicators of intervention engagement (ie, total number of logins, total number of minutes used, and total number of unique days of use) and in turn through increases in mean acceptance of internal cues to smoke from baseline to 3 months. Analyses of the acceptance subscales showed that the mediation was through acceptance of physical sensations and emotions, but not acceptance of thoughts. There was no evidence that the effect of the iCanQuit intervention was mediated through changes in valued living.ConclusionsIn this first study of serial mediators underlying the efficacy of smartphone apps for smoking cessation, our results suggest the effect of the iCanQuit ACT-based smartphone app on smoking cessation was mediated through multiple indicators of engagement and in turn through increases in the acceptance of physical sensations and emotions that cue smoking.Trial RegistrationClinical Trials.gov NCT02724462; https://clinicaltrials.gov/ct2/show/NCT02724462

JUST TRAC IT! TRANSITIONING RESPONSIBLY TO ADULT CARE USING SMART PHONE TECHNOLOGY

BACKGROUND Many adolescents living with heart disease face challenges when transitioning from pediatric to adult care. There is little evidence on how use of smartphone technology influences transition readiness. Just TRAC it! is a method of using existing features on a smartphone, including the Notes, Calendar, and Contacts apps, as a way for adolescents and adults to manage their health. We aimed to investigate the impact of nurse-led teaching with vs. without Just TRAC it! on self-management skills in this population. METHODS AND RESULTS We conducted a randomized clinical trial of 16-18 year olds with congenital heart disease (CHD) or acquired heart disease requiring surgery. Participants were randomly allocated 1:1 to either usual care (control; 1-hour education session) or the smartphone intervention (1-hour education session including Just TRAC it!). The primary outcome was change in TRANSITION-Q score between baseline, 3 and 6 months. Secondary outcomes were frequency of use and perceived usefulness of Just TRAC it! at 3 and 6 months post intervention. Analysis was intention to treat. We enrolled 68 patients (41% female, mean age 17.3 years). Cardiac diagnosis was simple CHD (34%), moderate CHD (49%), complex CHD (13%), and acquired heart disease (4%). Sixty-eight percent had previous cardiac surgery and 26% had a previous cardiac catheterization. TRANSITION-Q scores were similar at baseline and increased over time in both groups (Figure) but were not significantly different between groups at 6 months. On average, TRANSITION-Q score at 6 months were 0.9 points higher than at 3 months (95% CI 0.1-1.7). Each additional point at the baseline score brought, on average, a 0.7 point increase in TRANSITION-Q score (95% CI 0.5-0.9) each at 3 months and at 6 months. Perceived usefulness of Just TRAC it! is summarized (Table). Ninety-seven percent of participants indicated they would recommend Just TRAC it! to others at 3 months and 100% at 6 months. CONCLUSION Nurse-led transition teaching with vs. without Just TRAC it! improved transition readiness based on TRANSITION-Q scores over time, with no significant difference between groups. The majority of participants found Just TRAC it! useful, with the camera, calendar and notes apps reported as the most useful. Participants had a positive reception to Just TRAC it! and would recommend it to others. Longer follow-up is needed to assess how smartphone technology is used by young adults to facilitate their entry into the adult healthcare system. Many adolescents living with heart disease face challenges when transitioning from pediatric to adult care. There is little evidence on how use of smartphone technology influences transition readiness. Just TRAC it! is a method of using existing features on a smartphone, including the Notes, Calendar, and Contacts apps, as a way for adolescents and adults to manage their health. We aimed to investigate the impact of nurse-led teaching with vs. without Just TRAC it! on self-management skills in this population. We conducted a randomized clinical trial of 16-18 year olds with congenital heart disease (CHD) or acquired heart disease requiring surgery. Participants were randomly allocated 1:1 to either usual care (control; 1-hour education session) or the smartphone intervention (1-hour education session including Just TRAC it!). The primary outcome was change in TRANSITION-Q score between baseline, 3 and 6 months. Secondary outcomes were frequency of use and perceived usefulness of Just TRAC it! at 3 and 6 months post intervention. Analysis was intention to treat. We enrolled 68 patients (41% female, mean age 17.3 years). Cardiac diagnosis was simple CHD (34%), moderate CHD (49%), complex CHD (13%), and acquired heart disease (4%). Sixty-eight percent had previous cardiac surgery and 26% had a previous cardiac catheterization. TRANSITION-Q scores were similar at baseline and increased over time in both groups (Figure) but were not significantly different between groups at 6 months. On average, TRANSITION-Q score at 6 months were 0.9 points higher than at 3 months (95% CI 0.1-1.7). Each additional point at the baseline score brought, on average, a 0.7 point increase in TRANSITION-Q score (95% CI 0.5-0.9) each at 3 months and at 6 months. Perceived usefulness of Just TRAC it! is summarized (Table). Ninety-seven percent of participants indicated they would recommend Just TRAC it! to others at 3 months and 100% at 6 months. Nurse-led transition teaching with vs. without Just TRAC it! improved transition readiness based on TRANSITION-Q scores over time, with no significant difference between groups. The majority of participants found Just TRAC it! useful, with the camera, calendar and notes apps reported as the most useful. Participants had a positive reception to Just TRAC it! and would recommend it to others. Longer follow-up is needed to assess how smartphone technology is used by young adults to facilitate their entry into the adult healthcare system.

간호대학생의 스마트폰 중독에 미치는 영향요인

This study is to investigate the related factors between depression, alcohol use disorder, and smartphone addiction among university students and to check the effect of each variable on smartphone addiction. The collected data were analyzed using the SPSS22.0 Program, and regression analysis was used to determine the effects of college students’ depression and alcohol use disorder on smartphone addiction. As a result of the study, there were statistically significant differences in smartphone addiction according to the subjects’ general characteristics in gender, interpersonal relationships, and smartphone usage time. Also, it was confirmed that depression and alcohol use disorder had a positive correlation with smartphone addiction, and the explanatory power of depression and alcohol use disorder for smartphone addiction was 16.5%. Based on the results of this study, when counseling and education for smartphone addiction among college students is applied, strategies are established in connection with mental health such as alcohol use disorder and depression, and research on smartphone addiction prevention and intervention programs considering these related factors is required.