BACKGROUND: The COVID-19 pandemic has increased the demand for mental health services but has also imposed new barriers for those seeking care, creating a widespread shortage. As a result, providers are increasingly looking to incorporate technology into mental healthcare. Despite the increased focus on mental health technology in recent years, many new technologies are framed as products rather than clinical tools and fail to be effectively implemented. Digital clinics, hybrids of clinical care and technology, such as a smartphone app, offer a model of how technology can be implemented into mental healthcare. In addition to increasing the need for technology in mental healthcare, the COVID-19 pandemic has also lessened many historical barriers to successful implementation of a digital clinic including regularity restrictions, financial challenges, and the motivations of patients and providers in adding technology into healthcare. Objective: In order to better understand how technology can be incorporated into mental healthcare, the Technology Enabled Care Program (TECC), a digital clinic at Beth Israel Deaconess Medical Center, will be evaluated through the study of a case series. The integrated-Promoting Action on Research Implementation in Health Services (i-PARISH) framework, an implementation science model, will be applied to TECC in order to identify factors important to the larger scale implementation of this digital clinic. METHODS: The TECC program combines eight sessions of face-to-face therapy via telehealth with the use of a mindLAMP, a mental health smartphone app. The app is customizable for each use case and is supported by a 3-member care team containing technology specialists and a therapist. Quantitative data from this program will be investigated and discussed along with information on patients’ qualitative experiences in order to get a better understanding of the successes and areas for improvement in this first implementation of TECC. RESULTS: From the six initial patients who have completed TECC, four were selected to be represented in this case series. One patient was highly engaged with the app and used it on a daily basis throughout the program. Two patients use the app consistently at times but experienced periods of low engagement during their care. A fourth patient struggled with technical issues and their app use was intermittent. Most feedback on the program was positive, but exceptions will be detailed. CONCLUSION: Implementation of the TECC program and mindLAMP app into practice was successful in many regards and these early cases shed light on areas of potential improvement in future iterations of the digital clinic. Moving forward, these results will inform a focus on factors that can increase adoption by patients, clinicians, and healthcare systems.

BACKGROUND: As smartphone devices have become a ubiquitous part of our modern lives, parents and clinicians have become increasingly concerned about the effects of digital media use on the mental well-being of adolescents and young adults. Smartphone ownership in youth has increased significantly over the last decade, paralleling the rise in mental health disorders. This study seeks to use the digital phenotyping (DP) methodology to elucidate these relationships. Most studies examining these variables use cross-sectional data in healthy adolescents. To our knowledge, no studies have used DP methodology to characterize the relationship between digital media use, depression and anxiety in a population of clinical adolescents. METHODS: 50 adolescent and young adults between the ages of 12-23 receiving outpatient mental health services from a community hospital network in the greater Boston area were enrolled. Participants installed an application on their personal smartphones that collected daily surveys that captured mood symptoms, digital media use (screen time, social media time, and top apps used [active data]), and that also continuously captured sensor data (GPS and accelerometer [passive data]) over six weeks. RESULTS: Using linear regression and multilevel modeling, no significant associations were found between screen time or social media time, and anxiety and depression symptoms. Productivity apps were used significantly more in those with no depression symptoms than in those with moderate to severe levels of depression. CONCLUSION: Our study results challenge the present intuition that the amount of digital media use negatively impacts mental well-being in youth. Total screen time and social media time measures may be insufficient when attempting to assess the impact of digital media engagement on youth. Additionally, the results of our study suggest that the types of apps used by youth may depend on an individual’s mood severity. Although not without limitations, DP studies may be the ideal methodology for capturing with greater granularity digital use behavior and its association with mood symptoms in adolescents. / 2022-11-22T00:00:00Z

Background: Atrial fibrillation (AF) confers high risk of stroke, but often goes undiagnosed due to difficulties in its diagnosis. AF detection is important in post-stroke populations for secondary prevention and smartwatches have emerged as a promising modality for detecting AF, but little is known about their use in older adults who have experienced a stroke. Methods: This dissertation uses data from the Pulsewatch study, a two-phased trial assessing accuracy, usability, and adherence of smartwatch-based AF detection among older patients after stroke. Analyses performed include: descriptive statistics, linear and logistic regressions, qualitative and mixed-methods analyses, mixed effects modeling, and group-based trajectory modeling. Results: The Pulsewatch system was 91% accurate in detecting AF compared to a clinical gold-standard. Participants found the system easy to use, but indicated that streamlining the smartwatch’s functionalities to focus on passive cardiac monitoring is crucial. Improving battery life to allow for longer wear time would alleviate anxiety in some participants. Participants with previous experience using cardiac rhythm monitors rated the system lower on usability, but overwhelmingly preferred it to previous monitors due to the watch’s comfort, appearance, and convenience. Watch wear decreased over time, and we observed three distinct patterns of decline. No individual-level characteristics were associated with usability or adherence to watch wear. Conclusions: Smartwatches are promising for AF detection in older adults after stroke, though while they offer high accuracy and usability, adherence to wear is low. Strategies to encourage extended watch wear are necessary to realize the potential of smartwatches as a viable cardiac monitoring modality.

A central assumption of extant mHealth literature is that the technology empowers health care staff and leads to increased efficiency in service delivery. This assumption foregrounds the transformative potential of mHealth and the active appropriation of the technology, but obscures how it integrates with existing workplace arrangements. To interrogate the limitations of this dominant assumption, this research examines how mHealth is coordinated in the workplace in practice, and the perceptions and experiences of health care staff of the place mHealth takes in their daily concerns. In this way the research reveals how existing workplace arrangements influence the way that mHealth operates in practice, and builds on extant research to clarify how this can shift responsibility for the success of the implementation onto those staff with the least recognition and security. An interpretive case study explores the coordination of mHealth in the workplace, and analyses unexpected outcomes to identify their implications for theory and practice. In order to highlight this phenomenon the research focussed on the experiences of the clinic staff who were responsible for mHealth implementation, but were not the end users and who did not receive direct benefits themselves. The analysis drew on coordination studies to identify social and artefact-based coordination mechanisms, as well as the significance of relationships in mHealth in the workplace, yielding robust evidence that social coordination mechanisms rather than the fitness for purpose of the specific technology shaped the coordination process. Issues arising from the specific setting also influenced coordination in important ways that were not predicted in the official training material. The research makes three theoretical contributions that advance understanding of mHealth in the workplace through abduction. First, it identifies two novel coordination mechanisms: role flexibility and covert routines. Second, through the novel concept of multiple accountability, it challenges one of the key integrative principles proposed in the coordination studies perspective, problematising it and proposing that relationships between health intermediaries and local communities are far more influential for the coordination of mHealth than extant theory has so far proposed. Third, it carries important implications for future mHealth (and, more broadly, technology coordination) scholarship, providing evidence that existing coordination mechanisms and relationships may be as influential as the transformative potential of the technology itself. The research also contributes to practice by enhancing understanding of how health intermediaries may be empowered to effectively employ mHealth in the workplace. In a context of policy and funding uncertainty, this research contributes to an emerging literature identifying the practical mHealth issues primary health care staff face in a resource-poor environment, interrogating approaches that fail to recognise these realities.

A healthy in utero environment is essential for achieving optimal outcomes for women and their children. Gestational weight gain (GWG) has been shown to impact current and future maternal-infant health outcomes. Suboptimal weight gain during pregnancy (defined by the Institute of Medicine GWG guidelines) has been linked to several complications and is implicated in the inter-general cycle of obesity. Understanding contributors to GWG and intervening during pregnancy with healthy behaviour strategies may have a multi-generational effect for chronic disease prevention. The objective of the first study of this thesis was to examine the association between i) eating habits during pregnancy, ii) advice from family or friends about GWG, and iii) personal effort to stay within weight gain limits, and meeting GWG recommendations. Cross-sectional data were collected from pregnant and postpartum women who responded to the validated electronic maternal (EMat) health survey. Regardless of receiving advice about GWG, women self-reporting less healthy eating habits in pregnancy than before pregnancy, receiving advice from family/friends about GWG, and lower personal effort to stay within guidelines, had an increased odds of weight gain discordant with recommendations. The objective of the second study was to assess the short-term effect of the SmartMoms Canada application (app) usage on promoting adequate GWG and healthy behaviours. SmartMoms Canada is an app-based intervention designed to help pregnant women adhere to GWG guidelines and improve healthful behaviours. Pregnant women using the SmartMoms Canada app more frequently had a higher moderate-to-vigorous physical activity daily average when compared with women with a lower usage. Together, the EMat and SmartMoms results from this thesis contribute to identifying and mitigating potential factors associated with discordant GWG and healthy behaviours.

The combination of declining birth rates and an aging Swedish population presents challenges for the government in terms of accommodating and providing for the needs of a larger and older population. This demographic shift will exert significant pressure on the public sector, particularly the healthcare system. The potential of digitized healthcare to address the challenges posed by the aging population is significant, and mHealth technologies may be part of the solution to addressing these challenges. This study seeks to examine and quantify the key factors that influence the attitudes of young elderly (ages 45-60) individuals in Sweden towards the adoption of mHealth technologies. Specifically, the research aims to assess the factors that impact willingness to adopt technologies for managing primary healthcare needs. By identifying and measuring these influencing factors, the study strives to contribute to a better understanding of the drivers behind the adoption of mHealth solutions among this demographic. The study employs a single-method research design with a deductive empirical approach, using an online survey to collect quantitative data through a snowballing sampling technique. The study introduced three new variables (General Technology Experience, Healthcare Technology Experience, and Security and Privacy) and three new moderators (Being a Parent, Highest Level of Education, and Frequency of Primary Care Visits) to the widely recognized UTAUT framework. The results were analyzed using Excel and SPSS to identify patterns, relationships, and trends that emerged from the empirical data. Via analysis of the collected survey data, it was found that Performance Expectancy strongly influences the adoption of mHealth technologies among young elderly Swedes. Social Influence and Security and Privacy have minimal impact on adoption decisions. Security and Privacy show a negative correlation to willingness to adopt, indicating mistrust. Higher education levels are associated with digital literacy and belief in technology's job performance benefits. Lower education levels correlate with higher social influence. Individuals visiting primary care 2-3 times a year exhibit higher technology experience and social influence.

Based on Kim Witte's proven Extended Parallel Process Model, a mobile communication system was developed in which men were sent reminders about their health. This study focused on reminding men about testicular self-examination (TSE), a proactive behavior used to detect testicular cancer, through the use of text messaging. A cohort of 75 men were recruited for this study and placed into one of four groups. All participants were provided with information concerning TSE and told to perform the exam monthly; two of the four groups were sent reminders via text message while the other two groups were told once about the behavior. An original 30-item survey was used to measure intention. Proper data analysis could not be performed due to an attrition rate of 71%. Nonetheless, a significant relationship was observed between pre- and post-test adherence as reported by the participants. In addition, the measurement tool was assessed and determined to be useful in measuring intention to perform TSE. Internal consistency measures were reported as 0.672 and 0.626, both of which would have been higher with a larger sample size. While further research and analysis is recommended, this study has laid a foundation for a way to communicate with young men about their health.

This project aims to explore how interactive technological artefacts can support young adults with sensory overload in their experiences. It intends to investigate the potential of carefully designing technologies tailored to the user's sensory needs of managing and reflecting on the sensory experience, and understanding their patterns. The project adopted an iterative design process and applied several methods with an emphasis on designing meaningful user experiences. The project conducted user research with people experiencing sensory overload to understand the experiential aspects of trying to manage the negative experiences it entails. The final design consists of two prototypes. The first one was a Role Prototype created with Figma and took the form of a mHealth app powered by Artificial Intelligence for detecting patterns in the user’s data and documenting sensory experiences through journaling. The second one is an Implementation prototype in the form of a tangible electronic prototype created by using Arduino Nano BLE 33 Sense and sensors for recognising biometric data and environmental cues. Additionally, technological exploration was undertaken through sketching in hardware. This led to delving into how Machine Learning and gas sensors can be combined in order to create a scent-detecting sensor. The results suggest that the design concept provides the user with valuable tools to manage their overwhelming sensory experiences. Lastly, the results indicate that a sensory experience prediction component would be a valuable feature for people who need to manage sensory overload.

Indiana University-Purdue University Indianapolis (IUPUI) / Background. People with psychotic disorders tend to die earlier than the general population, primarily due to preventable cardiovascular disease. Behavioral risk factors, such as poor diet, have been identified as major contributors. Given the importance of prevention, the early stages of psychosis have been described as a “critical” time to intervene on health behaviors. As such, a mobile-based intervention, Nutrition Enhancement in Early Psychosis (NEEP) was created to improve diet quality in persons with early psychosis. This study has three aims: (1) assess the feasibility of the intervention, (2) examine preliminary outcomes, and (3) investigate mechanisms associated with dietary change. Methods. NEEP incorporates a combination of nutrition education, goal setting, and mobile technology (i.e., a mobile application for dietary tracking, as well both automated and personalized text-messages). Given the pilot nature of the study, all participants (N=15) received the intervention. Feasibility was assessed through different metrics related to recruitment and adherence to the dietary tracking application, as well as self-report responses regarding acceptability. Preliminary outcomes (i.e., two measures of diet quality) and potential mechanisms of change (i.e., self-efficacy and motivation) were also evaluated using paired sample t-tests. Qualitative interviews were conducted following study participation. Given the emphasis on feasibility with a small sample, all significance tests were set at p <.10, and Hedges g was used to examine effects over time. Results. 15 participants were enrolled in the study and 12 participants completed follow-up assessments. Evaluative measures of feasibility suggest that the majority of those who were screened enrolled in this intervention and regularly engaged with the mobile tracking device to record their dietary consumption. In addition, participants enjoyed the intervention and found it to be useful in improving their diet. Preliminary evidence also suggests this intervention may improve diet quality. As such, one indicator of improvement in diet quality was considered significant (Rapid Eating Assessment for Participants- Shortened; p=.084), and both measures of diet quality suggested improvement in diet at the end of the 28-day intervention with small to medium effect sizes (REAP-S g=.44; Heathy Eating Index-2015 g=.69). Contrary to hypotheses, self-efficacy significantly decreased after the intervention (p=.028) and motivation remained relatively stable. Conclusion. Results suggest that NEEP is feasible as a low-cost, low-resource mobile intervention that is well-tolerated and may improve diet quality in people with early psychosis; however, mechanisms of change require further exploration.

mHealth, mobile Health, is the use of applications on mobile devices todisseminate health information. mHealth applications exist for severaldifferent purposes, of which diet and exercise applications are a large part.The possibilities for these applications are substantial but it also increasesthe number of challenges. The applications need to be effective in assistingthe user, have necessary information, and be useful to be successful. There aremany factors that influence success in the development of applications. Thisstudy was based on a theoretical framework for the success of mHealthapplications to evaluate the usefulness of diet and exercise applications. Thetheoretical framework consists of four factors: information quality,instructing, reliability, and system quality. To carry out the study, aqualitative approach was used where six respondents were selected, theserespondents were instructed to use one of two applications selected for thestudy, over a period of time. After the period, observations were made withfour scenarios for each of the respondents after which semi-structuredinterviews were performed. Respondents could see both pros and cons in theapplications that were tested, but one main point that emerged was that acontinuous use was not likely. The study shows that users view of continuoususe may have been affected by the inadequacies in system quality and lack ofpersonalization that the applications revealed. In order to increase theusability of the applications, these inadequacies should therefore be reviewedand resolved. / mHealth, mobile Health, är   användandet av applikationer på mobila enheter för att sprida   hälsoinformation. mHealth applikationer finns för flera olika ändamål varav   kost- och träningsapplikationer är en stor del. Möjligheterna för dessa   applikationer är stora men det gör även de utmaningar som finns på vägen   fler. Applikationerna behöver vara effektiva i att hjälpa användaren, ha   nödvändig information samt vara användbara för att bli framgångsrika. I   utvecklandet av applikationer så är det många faktorer som påverkar   framgången. Denna studie har utgått ifrån ett teoretiskt ramverk för framgång   av mHealth applikationer för att undersöka användbarheten i kost- och   träningsapplikationer. Det teoretiska ramverket består av fyra faktorer:   Informationskvalitet, Instruerande, Pålitlighet och Systemkvalitet. För att   genomföra studien har en kvalitativ ansats använts där sex respondenter valts   ut, dessa respondenter fick under en period använda en av två applikationer   som valdes för studien. Efter perioden genomfördes observationer där fyra scenarion   utfördes av var och en av respondenterna, observationerna följdes upp av   semistrukturerade intervjuer. Respondenterna kunde se både för- och nackdelar   i de applikationer som testades men en huvudsaklig punkt som framkom var att   ett kontinuerligt användande inte var troligt. I studien framkommer det att   användarnas syn på kontinuerligt användande kan ha påverkats av de brister i   systemkvalitet och brist på personlig anpassning som applikationerna visade   på. För att användbarheten i applikationerna ska öka bör därför dessa brister   ses över och åtgärdas.