Technology in Behavioral Science

Relationship Between Parent Distraction with Technology at Mealtimes and Child Eating Behavior: a Pilot Study

A Practical Guide for Health Service Providers on the Design, Development, and Deployment of Smartphone Apps for the Delivery of Clinical Services Abstract The availability of healthcare-focused smartphone applications, or "apps," has grown exponentially over the last decade. Despite widespread usage, many have been concluded to lack both a research-informed design, and empirical testing, leading some healthcare providers to consider developing their own. Self-designing can not only lead to the addressing of potential concerns with commercially available apps, but could also allow for the creation and tailoring of such programs to the unique needs of the provider or their treated population. While development can be an exciting and mentally stimulating endeavor, there are many concerns and considerations that healthcare providers should evaluate when designing, creating, and assessing a smartphone app. Unfortunately, few resources currently exist to guide providers through such a process. As such, the purpose of this research- and experience-informed synthesis is to briefly outline the general process and considerations a healthcare provider should evaluate when developing an evidence-informed healthcare app.

College Students' Attitudes About Mental Health-Related Content in Mobile Apps Abstract This original study explored college students' mobile phone app usage, and their attitudes about the usefulness of mental health-related content in a mental health-related mobile phone app and a mobile app linked to their college. More than half of the 113 undergraduate and graduate students indicated goal-setting assistance, stress management resources, well-being information, mental health resources, and contact information of local mental health agencies would be very to extremely useful in a mobile phone app linked to their college. Campus-based mobile phone apps could provide an alternative method for students to seek mental health-related services and may improve college students' poor help-seeking behaviors.

Smart Ways to Use Smartphones in Adolescent Mental Health Treatment

Use of Health Technologies for Low Back Pain in the Military Health System Abstract Low back pain (LBP) is a widespread condition that poses specific occupational risks for active-duty military personnel. Barriers to treatment are also greater for military personnel and veterans. The authors conducted a review of the literature to identify technology solutions to help offset barriers to treatment for military personnel and veterans. Researchers conducted a PubMed search using subject headings and natural language terms and phrases. Three research psychologists screened abstracts and full text articles. After application of exclusion criteria, 28 key articles on treatment of LBP leveraging technology were included. There is evidence in medical literature for the efficacy of health technology in the treatment of LBP. Telehealth can be effective in reducing pain levels, and more convenient and cost-effective than treatment as usual (TAU). Smartphone and mobile apps are effective for managing LBP by providing self-management tools and tracking methods. Internet-based programs are highly accessible, cost-effective, and less stigmatized than TAU. Wearable technologies, such as biofeedback and electronic sensors, are effective for reducing pain and improve physical rehabilitation assessment and treatment for chronic LBP. Findings for emerging technologies are reviewed and discussed. Considerable evidence exists for incorporating technology into treatment programs for LBP. The most promising technologies were as follows: telehealth, internet-based programs, and mobile apps. Benefits of using technology in treatment programs included not only reduction in pain symptoms, but also enabling self-management, allowing anonymous participation, portability of treatment, and cost effectiveness.

The Monetization Strategies of Apps for Anxiety Management: an International Comparison Abstract Many mobile applications (apps) are available for anxiety management, but little is known about how their monetization strategies influence their success. This study evaluates how monetization strategies differ between anxiety apps intended for the United States (US) and People's Republic of China markets, and which monetization strategies are most associated with commercial success. During July 2018, the US and China versions of the iOS App Store were queried for apps mentioning anxiety. Apps were then reviewed to determine whether they cost money to download, offered in-app purchases, or had a subscription fee. The number of reviews and average ratings apps received were recorded as measures of commercial success. The relationships between nation, monetization strategy, and commercial success were assessed using both chi-square tests and multivariate regressions. Selection criteria were met by 382 apps. Most (346) of the apps were from the US store. Apps were significantly (P < 0.05) more likely to be completely free in the China store (41.7%) than in the US store (25.4%). Apps from the US store were significantly more likely to have a download fee (P < 0.01) and to have a subscription model (P < 0.001). Subscription models were significantly (P < 0.01) associated with more ratings and with apps being more likely to be rated 4+ on a 5-point scale (P < 0.01). Anxiety apps in the US and China used different monetization strategies. Subscription models were associated with commercial success.

Peer Support: a Human Factor to Enhance Engagement in Digital Health Behavior Change Interventions Abstract The purpose of this report is to develop a theoretical model based on empirical evidence that can serve as a foundation for the science of peer-support factors that facilitate engagement in digital health interventions for people with serious mental illness (SMI). A review of the literature on how peer-support specialist interaction with consumers with SMI in digital health behavior change interventions enhances engagement. Unlike relationships with other health providers, peer-to-consumer relationships are based on reciprocal accountability —meaning that peer-support specialists and consumer mutually help and learn from each other. Under the recovery model of mental illness, reciprocal accountability suggests autonomy, flexible expectations, shared lived experience, and bonding influence engagement in digital interventions. Separate yet related components of reciprocal accountability in the context of digital health intervention engagement include (1) goal setting, (2) task agreement, and (3) bonding. Hope and sense of belonging are hypothesized moderators of peer-support factors in digital health interventions. Peer-support factors help people with SMI learn to live successfully both in the clinic and community. Peer-support specialists add value and complement traditional mental health treatment through their professional training and lived experience with a mental illness. The proposed model is a pioneering step towards understanding how peer-support factors impact engagement in digital health behavior change interventions among people with a lived experience of SMI. The model presents proposed factors underlying the reciprocal accountability processes in the context of digital health intervention engagement. This model and related support factors can be used to examine or identify research questions and hypotheses.

A Telehealth Framework for Mobile Health, Smartphones, and Apps: Competencies, Training, and Faculty Development Abstract Technologies like smartphones and apps are reshaping life, health care, and business. Clinicians need skills, knowledge, and attitudes to ensure quality care and to supervise the current generation of trainees, consistent with the Institute of Medicine's Health Professions Educational Summit. Literature is integrated on patient-, learner-, competency-, and outcome-based themes from the fields of technology, health care, pedagogy, and business. Mobile health, smartphone/device, and app competencies are organized in the Accreditation Council for Graduate Medical Education (ACGME) Milestone domains of patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication. Teaching methods are suggested to align competency outcomes, learning context, and evaluation. Services by mobile health, smartphone/device, and apps have a broader scope than in-person and telehealth and telebehavioral health care. This includes clinical decision support in medicine, hybrid delivery, and integration across health systems' e-platforms. A curriculum with seminar, case- and problem-based teaching, supervision, evaluation, and quality improvement practices is needed to achieve competency outcomes. Clinicians have to adjust assessment, triage and treatment and attend to ethical, privacy, security, and other challenges. Health systems need to manage change, proactively plan faculty development, and create a positive e-culture for learning. Research is needed on implementing and evaluating mobile health competencies for this significant paradigm shift in health care.

Mobile Health Provider Training: Results and Lessons Learned from Year Four of Training on Core Competencies for Mobile Health in Clinical Care Abstract This article describes the results of the delivery of the fourth year of the delivery of a competency-based training program to train providers on best practices for mobile health in clinical care. During a 1-year span of time eight 1-day training workshops were delivered, training 252 providers and clinical support staff on best practices for mobile health in clinical care. Quality and effectiveness of training was evaluated and data was collected regarding provider technology use. Comparisons with previously published results were made and lessons learned for increasing reach and effectiveness of training were provided. Results showed that the training was effective in increasing knowledge and skills on the core competencies for mobile health in clinical care. Prior to the training, 48.5% reported integrating mobile health in clinical care, and following the training, 95.8% reported the intention to use mobile health. Follow-up results indicated that these results were maintained over time (83.3%), although limitations in the validity of follow-up data due to low response rates were noted. In order for clinicians to fully leverage the benefits of mobile health, training on mobile health is necessary. The current competency-based mobile health provider training is a mature, standardized, and effective solution that can serve as a model for existing and future mobile health training programs.

Integration of mCare and T2 Mood Tracker: Illustrating mHealth Usability Testing Abstract Military operational requirements potentially limit access to behavioral health care for service members. Although mobile technology solutions are increasingly viable, a secure method for mobile data exchange between patients and providers has yet to be adopted in military health care. Usability testing is the industry standard prior to implementing new technology. This paper demonstrates usability testing on a secure data exchange system between mCare and T2 Mood Tracker. Sixteen civilian providers in an outpatient behavioral health clinic tested the mCare Provider Portal, and nine uniformed proxy patients tested the Mood Tracker app. The System Usability Scale (SUS) was used as an outcome measure, which is composed of usability and learnability sub-factors. Proxy patients rated the mobile app as acceptable on the SUS, with average usability and above average learnability. Providers had less favorable views of the mCare Provider Portal, which they rated as marginal across all domains. Participants expressed enthusiasm about the potential of the provider web portal/patient smartphone app system, but had concerns about technical difficulties and ethical issues when exchanging data electronically. The results suggest a willingness to use technology to share data between patients and providers, but also a need for refinement of system usability before full-scale implementation.

Alexandros Sfakianakis
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alsfakia@gmail.com