White Paper: Open Digital Health – accelerating transparent and scalable health promotion and treatment

Kwaśnicka, Dominika; Keller, Jan; Perski, Olga; Potthoff, Sebastian; Hoor, Gill A. ten; Ainsworth, Ben; Crutzen, Rik; Dohle, Simone; Dongen, Anne van; Heino, Matti Toivo Juhani; Henrich, Julia F; Knox, Liam; König, Laura M; Maltinsky, Wendy; McCallum, Claire; Nalukwago, Judith; Neter, Efrat; Nurmi, Johanna; Spitschan, Manuel; Beurden, Samantha B van; Laan, Laura N. van der; Wunsch, Kathrin; Levink, Jasper J.J.; Sanderman, Robbert

doi:10.1080/17437199.2022.2046482

Cited by 27 publications

(23 citation statements)

References 72 publications

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“…This study highlights the importance of comprehensive investigations of engagement during the development of evidence-based app-based interventions. Future research would benefit from comprehensive, longitudinal analyses, as well as primary studies that specifically assess the effects of varying levels of engagement trials on health outcomes (eg, microrandomized trials, rapid optimization methods, and multiphase optimization strategies) [18,[62][63][64]. As research continues, understanding the effects of engagement with app-based intervention features on clinical outcomes will be critical to designing targeted interventions needed to increase patient health and support accessible, comprehensive care.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…To date, research on engagement remains limited and is often not assessed, as app-based interventions are still largely analyzed using conventional methods (eg, intent to treat) [ 18 ]. This method evaluates the effect of assignment to treatment (ie, the effect of being randomized to a group) instead of the direct effect associated with the app features that were actually used during the intervention [ 18 ]. Analyzing which features the user engages with is critical to designing personalized, effective interventions [ 14 ] and allows researchers to understand which in-app features drive changes in health outcomes [ 14 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Analyzing the Impact of Mobile App Engagement on Mental Health Outcomes: Secondary Analysis of the Unwinding Anxiety Program

Nardi¹,

Roy²,

Dunsiger³

et al. 2022

J Med Internet Res

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Background App-based interventions provide a promising avenue for mitigating the burden on mental health services by complimenting therapist-led treatments for anxiety. However, it remains unclear how specific systems’ use of app features may be associated with changes in mental health outcomes (eg, anxiety and worry). Objective This study was a secondary analysis of engagement data from a stage 1 randomized controlled trial testing the impact of the Unwinding Anxiety mobile app among adults with generalized anxiety disorder. The aims of this study were 2-fold: to investigate whether higher microengagement with the primary intervention feature (ie, educational modules) is associated with positive changes in mental health outcomes at 2 months (ie, anxiety, worry, interoceptive awareness, and emotional reactivity) and to investigate whether the use of adjunctive app features is also associated with changes in mental health outcomes. Methods We analyzed the intervention group during the stage 1 trial of the Unwinding Anxiety mobile app. The total use of specific mobile app features and the use specific to each feature were calculated. We used multivariate linear models with a priori significance of α=.05 to investigate the impact of cumulative app use on anxiety, worry, interoceptive awareness, and emotional regulation at 2 months, controlling for baseline scores, age, and education level in all models. Significant relationships between system use metrics and baseline participant characteristics were assessed for differences in use groupings using between-group testing (ie, 2-tailed t tests for continuous data and chi-square analyses for categorical data). Results The sample was primarily female (25/27, 93%), and the average age was 42.9 (SD 15.6) years. Educational module completion, the central intervention component, averaged 20.2 (SD 11.4) modules out of 32 for the total sample. Multivariate models revealed that completing >75% of the program was associated with an average 22.6-point increase in interoceptive awareness (b=22.6; SE 8.32; P=.01; 95% CI 5.3-39.8) and an 11.6-point decrease in worry (b=−11.6; SE 4.12; P=.01; 95% CI −20.2 to −3.1). In addition, a single log unit change in the total number of meditations was associated with a 0.62-point reduction in the Generalized Anxiety Disorder-7 scale scores (b=0.62; SE 0.27; P=.005; 95% CI −1.2 to −0.6), whereas a single log unit use of the stress meter was associated with an average of a 0.5-point increase in emotional regulation scores (Five Facet Mindfulness Questionnaire; b=0.5; SE 0.21; P=.03; 95% CI 0.1-0.9). Conclusions This study offers a clearer understanding of the impact of engagement with app features on broader engagement with the health outcomes of interest. This study highlights the importance of comprehensive investigations of engagement during the development of evidence-based mobile apps.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Analyzing the Impact of Mobile App Engagement on Mental Health Outcomes: Secondary Analysis of the Unwinding Anxiety Program

Nardi¹,

Roy²,

Dunsiger³

et al. 2022

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…Since the randomized-controlled trial (RCT) as the gold standard in intervention evaluation is often too restrictive to fit to the diverse types of interventions, the research methods to evaluate their success need to vary according to the type of intervention including qualitative, quantitative, economic and participative methods ( 25 ). In addition, new ways to evaluate the effectiveness of digital health tools are needed that allow for capturing dynamic changes of digital health interventions over time ( 26 ). Additionally, more research is needed in developing evaluation strategies to tackle the lengthy and costly nature of RCTs.…”

Section: New Ways To Evaluate Health Education and Promotion Programmesmentioning

confidence: 99%

Grand Challenges for Public Health Education and Promotion

Stock

2022

Front. Public Health

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“…One of these peripheral factors is the change in attitudes and beliefs regarding the effectiveness of eHealth schemes, and the willingness of both patients and providers to interact over an electronic medium (33)(34)(35). Changes in beliefs and attitudes, as well as the politics and values associated with these beliefs, are often a major focal point of improving uptake of a given intervention or initiative (36,37). By adjusting these beliefs, there is room for innovative practices to take hold and become incorporated into the standard practice of these rural health centres, without a rollback being inherent in their implementation.…”

Section: Chapter 2: Introductionmentioning

confidence: 99%

Addressing Rural Health Access Inequity by Assessing Potential and Organizational Readiness for Antifragile Electronic Health Project Design in Rural Communities

Petrie¹

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There is a rural health access equity gap (especially for specialist care) within Canadian and international universal healthcare systems. Electronic health (eHealth) can address that gap, but pilot projects rarely scale to other contexts, or sustain in their original settings. Antifragile design and complexity informed principles can improve pilot project lifespans. Antifragile entities gain stability from uncertainty, rather than lose integrity. Antifragile operators include Chapter 1: Impact of the Novel Coronavirus (COVID-19) Pandemic on Doctoral Research ActivitiesSome problems are so complex that you must be highly intelligent and well informed just to be undecided about them.~Laurence J. PeterIn the winter of 2020, my research was following closely to the timelines outlined in the Carleton Health Sciences PhD stream table. Partnerships were being built with organizations who had interest in both electronic health (eHealth) and implementation. Chief among those institutional partners was the IWK health centre in Halifax, specializing in pediatrics and critical care. Through a CIHR funded health systems impact fellowship, I would have been embeddedwithin their organization for a year to assess the readiness of adopting a clinical information system at multiple sites across the province of Nova Scotia. Instead, that partnership, as well as a partnership with the Ontario Telehealth Network (OTN) and a local initiative out of the Ottawa Civic emergency department, were cut short as goals and resources shifted to combat the global COVID-19 pandemic.This has had a profound effect on my research, both positively and negatively, and has required adjustments regarding how I collected my data, the context of previously collected data, and how I should rectify my recommendations with the realities of a COVID-19 encumbered health system. Adverse effects of the pandemic are chiefly the break down of personal

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White Paper: Open Digital Health – accelerating transparent and scalable health promotion and treatment

Cited by 27 publications

References 72 publications

Analyzing the Impact of Mobile App Engagement on Mental Health Outcomes: Secondary Analysis of the Unwinding Anxiety Program

Analyzing the Impact of Mobile App Engagement on Mental Health Outcomes: Secondary Analysis of the Unwinding Anxiety Program

Grand Challenges for Public Health Education and Promotion

Addressing Rural Health Access Inequity by Assessing Potential and Organizational Readiness for Antifragile Electronic Health Project Design in Rural Communities

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