Dyadic digital health interventions: Their rationale and implementation.
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ABSTRACT:
SUBMITTER: Shaffer KM
PROVIDER: S-EPMC9668031 | biostudies-literature | 2022
REPOSITORIES: biostudies-literature
Publications
Dyadic digital health interventions: Their rationale and implementation.
Shaffer Kelly M KM Mayberry Lindsay S LS Salivar Emily Georgia EG Doss Brian D BD Lewis Amanda M AM Canter Kimberly K
Procedia computer science 20220921
While most psychosocial and behavioral digital health interventions have been designed to be consumed by an individual, intervening at the level of a dyad - two interdependent individuals - can more comprehensively address the needs of both individuals and their relationship. The clinical utility of the dyadic digital health intervention approach, as well as the practical implementation of this design, will be demonstrated via three examples: eSCCIP, FAMS, and OurRelationship. ...[more]
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Project description:U.S. health care systems are tasked with alleviating the burden of mental health, but are frequently underprepared and lack workforce and resource capacity to deliver services to all in need. Digital mental health interventions (DMHIs) can increase access to evidence-based mental health care. However, DMHIs commonly do not fit into the day-to-day activities of the people who engage with them, resulting in a research-to-practice gap for DMHI implementation. For health care settings, differences between digital and traditional mental health services make alignment and integration challenging. Specialized attention is needed to improve the implementation of DMHIs in health care settings so that these services yield high uptake, engagement, and sustainment. The purpose of this article is to enhance efforts to integrate DMHIs in health care settings by proposing implementation strategies, selected and operationalized based on the discrete strategies established in the Expert Recommendations for Implementing Change project, that align to DMHI-specific barriers in these settings. Guidance is offered in how these strategies can be applied to DMHI implementation across four phases commonly distinguished in implementation science using the Exploration, Preparation, Implementation, Sustainment Framework. Next steps to advance research in this area and improve the research-to-practice gap for implementing DMHIs are recommended. Applying implementation strategies to DMHI implementation will enable psychologists to systematically evaluate this process, which can yield an enhanced understanding of the factors that facilitate implementation success and improve the translation of DMHIs from controlled trials to real-world settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Project description:Globally, most young people living with mental health conditions lack access to mental health care but have access to a mobile device. The growing access to mobile devices in South Africa has the potential to increase access to mental health care services through digital platforms. However, uptake of digital mental health interventions may be hampered by several factors, such as privacy, confidentiality, informed consent, and affordability. This study identified the prospects and challenges of implementing a mobile phone-based mental health intervention for young people in Ingwavuma area. Data were collected from 93 young people in three villages purposefully selected in Ingwavuma area. Participants included in the study were aged 16-24. Data were collected through a questionnaire. Thematic and descriptive analysis was performed on the qualitative and quantitative data, respectively. Mental health education was low, with only 22% of participants having received prior education on mental health. About 50% of the participants had come across a mental health app, but none of them had used any of these apps; 87% of participants had Internet access; 60% preferred to use social media to contact a health worker; and 92% suggested that use of digital apps would improve mental health literacy among young people. Barriers to access of digital mental health interventions were identified as the high cost of data, restrictive religious beliefs, limited privacy, lack of native languages on most digital platforms, low digital literacy, and complicated user interface. In uMkhanyakude, uptake of digital mental health apps among the young people was low. We recommend that, developers create context-specific digital applications catered for young people from different cultural backgrounds. Socio-economic issues such as affordability also need to be addressed in developing these tools.
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Project description:BackgroundYoung people are particularly at risk of developing mental health problems, a challenge exacerbated by the COVID-19 pandemic. Digital tools such as apps and chatbots show promise in providing accessible, cost-effective, and less stigmatized ways of strengthening their mental health. However, while these interventions offer benefits, they extend mental health measures beyond traditional therapeutic settings and relationships, which raises ethical concerns due to the absence of established guidelines and regulations. This is particularly notable for technologies incorporating serious gaming elements. In addition, adolescents are in a sensitive and at times vulnerable phase, which shows great potential for the effective use of preventive and sensitizing mental health measures. Considering the lack of an integration into existing mental health structures among many young users, ethical considerations become crucial.ObjectiveThis scoping review aims to build a knowledge base on the ethical aspects of developing and implementing gamified digital mental health interventions for young people.MethodsWe conducted a search on research articles and conference papers from 2015 to 2023 in English, German, and Spanish. We identified 1815 studies using a unique combination of keywords in the databases Scopus, Web of Science, MEDLINE, and PsycINFO. After removing duplicates (741/1816, 40.8%), we included a total of 38 publications in this review following a double screening process.ResultsThis review found that ethically relevant aspects were discussed with regard to (1) research ethics, (2) ethical principles (including privacy, accessibility, empowerment and autonomy, cultural and social sensitivity, and co-design), (3) vulnerable groups, and (4) social implications (including implementation using facilitators in specific social contexts, relationship with other therapeutic options, economic aspects, and social embeddedness of technologies).ConclusionsThis scoping review identified a prevailing limited interpretation of "ethics" as research ethics across the included publications. It also shows a lack of discussion on the social embeddedness of technologies and that co-design is frequently viewed in instrumental terms and vulnerability is mostly addressed pragmatically. Through providing concrete examples of how mental health researchers and game designers thus far have addressed and mitigated ethical challenges in specific interventions, this review illustrates how ethical issues do or do not prompt diverse reflections, mitigation strategies, and actions. It advocates for ethics to be integrated as an ongoing practice throughout all stages of developing and implementing serious game elements in mental health interventions for young people.
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Project description:BackgroundDigital health interventions have become increasingly common across health care, both before and during the COVID-19 pandemic. Health inequalities, particularly with respect to ethnicity, may not be considered in frameworks that address the implementation of digital health interventions. We considered frameworks to include any models, theories, or taxonomies that describe or predict implementation, uptake, and use of digital health interventions.ObjectiveWe aimed to assess how health inequalities are addressed in frameworks relevant to the implementation, uptake, and use of digital health interventions; health and ethnic inequalities; and interventions for cardiometabolic disease.MethodsSCOPUS, PubMed, EMBASE, Google Scholar, and gray literature were searched to identify papers on frameworks relevant to the implementation, uptake, and use of digital health interventions; ethnically or culturally diverse populations and health inequalities; and interventions for cardiometabolic disease. We assessed the extent to which frameworks address health inequalities, specifically ethnic inequalities; explored how they were addressed; and developed recommendations for good practice.ResultsOf 58 relevant papers, 22 (38%) included frameworks that referred to health inequalities. Inequalities were conceptualized as society-level, system-level, intervention-level, and individual. Only 5 frameworks considered all levels. Three frameworks considered how digital health interventions might interact with or exacerbate existing health inequalities, and 3 considered the process of health technology implementation, uptake, and use and suggested opportunities to improve equity in digital health. When ethnicity was considered, it was often within the broader concepts of social determinants of health. Only 3 frameworks explicitly addressed ethnicity: one focused on culturally tailoring digital health interventions, and 2 were applied to management of cardiometabolic disease.ConclusionsExisting frameworks evaluate implementation, uptake, and use of digital health interventions, but to consider factors related to ethnicity, it is necessary to look across frameworks. We have developed a visual guide of the key constructs across the 4 potential levels of action for digital health inequalities, which can be used to support future research and inform digital health policies.
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Project description:BACKGROUND:Dyadic psychosocial interventions have been found beneficial both for people coping with mental or physical health conditions as well as their family members and friends who provide them with support. Delivering these interventions via electronic health (eHealth) may help increase their scalability. OBJECTIVE:This scoping review aimed to provide the first comprehensive overview of dyadic eHealth interventions for individuals of all ages affected by mental or physical illness and their family members or friends who support them. The goal was to understand how dyadic eHealth interventions have been used and to highlight areas of research needed to advance dyadic eHealth intervention development and dissemination. METHODS:A comprehensive electronic literature search of PubMed, EMBASE, Cochrane, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO was conducted for articles published in the English language through March 2019. Eligible records described a psychosocial eHealth intervention that intervened with both care recipients and their support person. RESULTS:A total of 7113 records were reviewed of which 101 met eligibility criteria. There were 52 unique dyadic eHealth interventions identified, which were tested across 73 different trials. Of the unique interventions, 33 were conducted among dyads of children and their supporting parent, 1 was conducted with an adolescent-young adult care recipient population, and the remaining 18 were conducted among adult dyads. Interventions targeting pediatric dyads most commonly addressed a mental health condition (n=10); interventions targeting adult dyads most commonly addressed cancer (n=9). More than three-fourths of interventions (n=40) required some human support from research staff or clinicians. Most studies (n=64) specified one or more primary outcomes for care recipients, whereas less than one-fourth (n=22) specified primary outcomes for support persons. Where specified, primary outcomes were most commonly self-reported psychosocial or health factors for both care recipients (n=43) and support persons (n=18). Results of the dyadic eHealth intervention tended to be positive for care recipients, but evidence of effects for support persons was limited because of few studies specifying primary outcomes for supporters. Trials of dyadic eHealth interventions were most commonly randomized controlled trials (RCTs; n=44), and RCTs most commonly compared the dyadic eHealth intervention to usual care alone (n=22). CONCLUSIONS:This first comprehensive review of dyadic eHealth interventions demonstrates that there is substantial, diverse, and growing literature supporting this interventional approach. However, several significant gaps were identified. Few studies were designed to evaluate the unique effects of dyadic interventions relative to individual interventions. There was also limited assessment and reporting of outcomes for support persons, and there were no interventions meeting our eligibility criteria specifically targeting the needs of older adult dyads. Findings highlight areas of research opportunities for developing dyadic eHealth interventions for novel populations and for increasing access to dyadic care.
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