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Background:
Early intervention is important in order to improve mental health outcomes for young people. Given the recent rise in mobile phone ownership among adolescents, an innovative means of delivering such intervention is through the use of mobile phone applications (apps).
Objective:
The aim of this study was to evaluate the feasibility of...
Context in source publication
Context 1
... world now owning smartphones [8-10]. This type of technology is a promising tool for the widespread delivery of telemental health interventions to young people. Because adolescents are familiar with how to use mobile phones (as they use them on a daily basis for texting, taking photos, playing games etc), they are unlikely to have much difficulty in adapting to the intervention interface [11]. Interventions delivered via mobile phones facilitate frequent engagement as users go about their daily lives [12,13] and afford users the opportunity to apply the skills and behaviors promoted by the intervention directly in real time to their real life experiences [14]. They can provide almost constant support to users, in comparison to interventions that can only be accessed at specific times or in specific locations (eg, during visits to a therapist’s office) [14]. Furthermore, as it is not unusual to see young people interacting with their mobile phones in public, they provide a discrete and confidential means of intervention delivery [11]. Over the coming years, it is predicted that the use of mobile technologies in mental health contexts will continue to rapidly increase [15]. Indeed, there are already a plethora of health care mobile apps available to adolescents [15], with over 3000 mental health apps accessible for download between the Android, Apple, and Microsoft app stores [16]. These apps have been developed by a wide range of individuals and organizations and are generally available free or at a small cost [17]. Some are targeted towards the assessment and treatment of specific mental health disorders, whereas others are focused on the more broad promotion of positive mental health [18] (ie, by fostering general well-being and resilience in individuals). Many of these apps are based on self-monitoring principles, where users rate how they are feeling on a day to day basis and are able to track their moods and emotions over time, for example “Moody Me” [19] and “Mood Panda” [20]. Some apps also provide advice on dealing with differing mental health concerns such as “Overcoming Depression” [21] and “Mental Health WATS” [22]. However, the problem with almost all of these apps is that they are not subject to regulatory assessments or empirical evaluations before they are made available to the general public and very few are supported by research indicting their effectiveness and usability [15,17,23]. This lack of research may be a consequence of most apps reaching consumers directly, without going through traditional medical gatekeepers [18]; however, it means that the quality of the content of these apps cannot be verified. Thus, the information these apps provide could be inaccurate or misleading, which at best may not be useful to users or at worst may cause them psychological harm [17]. There is a growing demand for studies evaluating the feasibility and efficacy of rigorously designed, evidence-based apps before they are made publically available through online platforms [7,15,23,24]. As rigorously designed evaluations often require the investment of significant resources, not all interventions can be tested for efficacy and effectiveness. Feasibility studies play an important role in identifying potentially efficacious interventions and ensuring they are prioritized for comprehensive evaluation [25]. Feasibility studies achieve this by exploring factors such as the acceptability of an intervention to participants, adherence and drop-out rates, and aspects of the intervention that may be altered to improve participants’ engagement [26], and are considered a crucial first step prior to the conduction of larger scale efficacy evaluations [27,28]. Whittaker et al [29], for example, explored the acceptability of cognitive behavioral therapy text-messages delivered twice daily to adolescents over nine weeks. They found that three-quarters of participants found the information useful and 90% would recommend the intervention to a friend. Similarly, Reid et al [30] explored usage patterns of a simple diary-based self-monitoring mobile app for adolescents and found engagement with the app was high, with nearly three-quarters of participants completing 80% or more of possible diary entries over the one-week intervention period. Findings from these studies are promising and suggest more complex app-based mental health interventions may be similarly feasible for use with adolescents. The objective of the present study was to evaluate the feasibility of a telemental health app, which aimed to foster positive mental health, for use by adolescents on their personal mobile phones. This study expands on previous research [29,30] by capturing detailed qualitative and quantitative feedback from adolescents pertaining to their satisfaction with, perceived usefulness of, and overall engagement with a telemental health app. The app in the present study was designed and programed for use on android and iOS mobile devices, following focus group consultation with adolescents in relation to their needs from mental health mobile technologies [31]. The aim of the app was to foster positive mental health via two key mechanisms: (1) emotional self-monitoring, and (2) the promotion of positive coping strategies. Increasing awareness of emotions is a process frequently used in therapeutic contexts [32] and periodically monitoring one’s emotions (ie, engaging in emotional self-monitoring) has been shown to facilitate increases in emotional self-awareness and improvement in mental health outcomes [33,34]. There is also a growing awareness in research literature that the ways in which young people cope with stressors may be significantly correlated with their mental health outcomes [1,35,36], and educating adolescents about coping strategies has been linked to increased use of positive coping strategies and improved mental health [37-39]. The app was branded “CopeSmart” and contains five main sections (see Figure 1 for sample screenshots). Section 1 (Settings) gives users the option to set and change their password for accessing the app and to manage their notification settings. By default the app is set to send reminder notifications to users to engage with it at 8pm each evening, as typically by this time of the day most adolescents are finished with school and after-school activities. Section 2 (Rate My Mood) allows users engage in emotional self-monitoring by rating how happy, angry, sad, stressed or worried they feel on a scale of 1-10. Section 3 of the app (Coping Tips) contains a series of “tips” for coping with problems. These tips were devised based on the “Think Positively” school-based course for developing positive ...
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Citations
... As study 1 was the first evaluation study on Steps, perceived app quality and feasibility were assessed using purpose-built open questions, informed by previous evaluation studies [14,[56][57][58]. The questions focused on app functionality, design, available features, and aspects of the implementation process (eg, "Steps makes my therapeutic work easier" or "The use of Steps fits well into everyday life on the ward"). ...
Background: Therapy-accompanying mental health apps can play an important role in the psychotherapeutic treatment of adolescents. They can enhance adolescents' engagement and autonomy, provide immediate support in critical situations, and positively influence the therapeutic working alliance. Nevertheless, mental health apps are rarely used by psychotherapists. Furthermore, due to the limited or nonexistent use of apps in psychotherapy, little is known about the actual barriers and drivers affecting their integration into psychotherapists' daily routines. To better understand how mental health apps should be designed for practical use, it is essential to explore psychotherapists' perspectives on key app features and characteristics, as well as the factors influencing their integration into clinical practice.
... A total of 1552 patients or users, the majority of whom were females (38 studies, 63.2%), were assessed for the usability and satisfaction of mHealth apps through cross-sectional studies. Eight studies were conducted among adolescents [18,19,27,42,45,47,48,50]. Moreover, three studies assessed the usability and satisfaction of females only, as the mHealth apps were designed for pregnancy [13,15] and breast cancer [16]. ...
... A few researchers have developed questionnaires consisting of Likert scale questions and open-ended questions [19,22,40,50] or mixed methods with interview questions [12,18,32,48]. The interviews and openended questions were intended to evaluate the recommendations to improve the apps and the satisfaction of the respondents with the app as well as the medical care service. ...
... The self-monitoring feature provides important emotional awareness to track and reflect on feelings and emotions to identify which promote positive or negative moods [19]. Previous research has also shown that self-monitoring mood is commonly included in many mobile mental health apps for young people and is the most liked and engaged with section [22,23]. ...
Background
Mobile health apps are proving to be an important tool for increasing access to psychological therapies early on, particularly with rising rates of anxiety and depression in young people.
Objective
We aimed to assess the usability, acceptability, safety, and effectiveness of a new app, Clear Fear, developed to help young people manage symptoms of anxiety using the principles of cognitive behavioral therapy.
Methods
The Clear Fear app was developed to provide cognitive behavioral strategies to suit anxiety disorders. An uncontrolled pre– and post–follow-up design over a 9-week period was used to assess the app and its effects. This study comprised 3 phases: baseline (stage 1), post–app familiarization phase (stage 2), and follow-up (stage 3). Eligible participants were aged between 16 and 25 years with mild to moderate anxiety but not currently receiving treatment or in contact with specialist mental health services or using other interventions or apps to help monitor or manage their mental health. A community sample was recruited via advertisements, relevant websites, and social media networks. Eligible participants completed standardized self-report tools and questionnaires at each study stage. These measured probable symptoms of anxiety (7-item Generalized Anxiety Disorder scale) and depression (Mood and Feelings Questionnaire); emotional and behavioral difficulties (Strengths and Difficulties Questionnaire); and feedback on the usability, accessibility, and safety of the app. Mean scores at baseline and follow-up were compared using paired 2-tailed t tests or Wilcoxon signed rank tests. Qualitative data derived from open-ended questions were coded and entered into NVivo (version 10) for analysis.
Results
A total of 48 young people entered the study at baseline, with 37 (77%) completing all outcome measures at follow-up. The sample was mostly female (37/48, 77%). The mean age was 20.1 (SD 2.1) years. In total, 48% (23/48) of the participants reached the threshold for probable anxiety disorder, 56% (27/48) had positive scores for probable depression, and 75% (36/48) obtained a total score of “very high” on the Strengths and Difficulties Questionnaire for emotional and behavioral difficulties. The app was well received, offering reassurance, practical and immediate help to manage symptoms, and encouragement to seek help, and was generally found easy to use. A small minority (3/48, 6%) found the app difficult to navigate. The Clear Fear app resulted in statistically significant reductions in probable symptoms of anxiety (t36=2.6, 95% CI 0.41-3.53; P=.01) and depression (z=2.3; P=.02) and behavioral and emotional difficulties (t47=4.5, 95% CI 3.67-9.65; P<.001), representing mostly medium to large standardized effect sizes.
Conclusions
The Clear Fear app was found to be usable, acceptable, safe, and effective in helping manage symptoms of anxiety and depression and emotional and behavioral difficulties.
... 28,29 Advantages of app-based interventions, broadly referred to today as digital therapeutics (DTx), include flexibility in use (i.e., time of day, location), tailored content, lower cost, and increased service capacity. Moreover, adolescents' perspectives on telehealth services are generally positive [30][31][32] and their digital literacy is unprecedented. Findings from populations with mental health symptoms akin to those of concussions suggest that DTx MBIs are effective for reducing stress, anxiety, sleep impairments, and fatigue, as well as improving quality of life. ...
... This is in line with pilot and feasibility trials that investigated the acceptability of mobile-based interventions for youth. [30][31][32] A limitation of prior digital technologies may be the lack of a therapeutic relationship or working alliance. In the current study, participants highlighted the importance of liking the mindfulness guides in their adherence to the MBI program. ...
Background
The ability to cope with concussion symptoms and manage stress is an important determinant of risk for prolonged symptoms.
Objective
This open-label mixed-methods pilot study assessed the acceptability and credibility of a mindfulness-based intervention delivered through a digital therapeutic (DTx; therapeutic smartphone app) for pediatric concussion.
Methods
Participants aged 12 to 18 years were recruited from an emergency department within 48 hours of a concussion (acute cohort) or from a tertiary care clinic at least 1-month post-concussion (persisting symptoms cohort). Participants completed a novel 4-week mindfulness-based intervention, for 10 to 15 minutes/day, at a minimum of 4 days/week. At 2 weeks, participants completed a credibility and expectancy questionnaire. At 4 weeks, participants completed questionnaires assessing satisfaction, usability and working alliance, as well as a semi-structured phone interview.
Results
Ten participants completed the study outcomes (7 acute; 3 persisting symptoms). The intervention was perceived as credible (median/max possible = 6.50/9.00 [6.83,8.75]) and DTx was usable (median/max possible = 70.00/100.00 [55.00,82.50]). Participants rated their satisfaction with the DTx (median/max possible = 27.00/32.00 [24.50,29.50]) and the working alliance with the digital mindfulness guides (median/max possible = 3.92/5.00 [3.38–4.33]) as high. Four themes were identified from the qualitative data: (a) positive attributes; (b) negative attributes; (c) ideas for modifications; and (d) technical issues.
Conclusion
Results show modifications to the DTx, instructions and mindfulness intervention, and potential ways to increase adherence by leveraging positive attributes. A randomized control trial will assess the effectiveness of the DTx MBI to decrease the risk of persisting symptoms and reduce the symptom burden following pediatric concussion.
... User satisfaction is critical to the long-term effectiveness and sustainability of technology-assisted anger management therapy. An investigation was conducted about the mobile application experience of teenagers and they discovered that enhanced adherence and engagement are strongly correlated with high levels of satisfaction [29]. Many times, the interactive and user-friendly design of these programs is attributed to their positive user experiences since it gives teenagers a sense of empowerment and autonomy [29]. ...
... An investigation was conducted about the mobile application experience of teenagers and they discovered that enhanced adherence and engagement are strongly correlated with high levels of satisfaction [29]. Many times, the interactive and user-friendly design of these programs is attributed to their positive user experiences since it gives teenagers a sense of empowerment and autonomy [29]. An examination of the long-term effects provides a thorough understanding of the durability and long-term impact of technology-assisted anger management techniques. ...
... The significant improvement in anger regulation shown in teens receiving technology-supported anger management therapy is a notable and enduring advantage. Numerous studies [29,30,31] have demonstrated that teens who engage in these therapies are better able to identify and regulate their angry reactions. Teens can identify triggers and learn suitable calming techniques by using smartphone applications with interactive exercises and real-time tracking features [32]. ...
This paper offers a thorough examination of the present condition and prospective advancements in technology-based anger management therapies for teenagers with aims to accomplish two objectives: firstly, to assess the efficacy of technology-assisted anger management programmes, and secondly, to examine the wider implications and obstacles associated with using technology into interventions for adolescent mental health. The
paper examines both traditional and technology-assisted interventions and highlights the good results they yield, including better anger management, more emotional intelligence, and greater coping mechanisms that are linked to technology-driven approaches. The literature study examines conventional psychotherapy and compares it to emerging technology-based approaches, particularly mobile applications, and virtual reality
programmes. The discourse assesses the effectiveness, user contentment, and lasting effects of technology-assisted interventions by analysing past research, offering valuable insights into the possibilities of these interventions. The effectiveness section provides a comprehensive analysis of favourable results, with a particular focus on the disadvantages of depending on technology and ethical concerns within the digital
environment. The practical implications underscore the incorporation of technology into programmes addressing the mental health of adolescents, the necessity of training mental
health practitioners in the use of technology, and the need to consider varied populations, particularly in Nigeria. Future directions entail the need to fill up gaps in research, investigate future technologies, and comprehend the lasting impacts of these
treatments.
... The use of RMT for symptom management through self-monitoring and feedback to health care professionals was often rated as useful by young people 98,99 and resulted in some reduction of depression symptom severity 100,101 . However, this reduction was not significantly different between self-monitoring and comparison groups 41,100-109 , unless outliers were removed 41 , or history of emotional abuse was considered 110 . ...
... While the overall impact of RMT on depression outcomes in young people remained inconclusive, self-monitoring specifically was consistently found to result in a greater increase in emotional self-awareness relative to comparison groups 7,99,101,103,104,[113][114][115] . Emotional self-awareness describes the ability to understand one's own emotions and is often low is those with depression 116 ; however, it can be increased through improved understanding of the links between certain events or thoughts and later emotions, behaviours and coping strategies. ...
... Throughout the literature, there was the assumption that RMT may be a natural fit for young people who have grown up during the digital revolution. Internet access and smartphone ownership in young people were relatively high, and perspectives on the use of RMT for depression were generally positive 38,47,98,99,103,107,121,123,[126][127][128][129][130] . However, usage statistics were quite low 127,131,132 , particularly for boys 127,132 despite the benefit they may gain from RMT through reduced perceived stigma and subsequent help-seeking behaviours 102 . ...
Digital mental health is becoming increasingly common. This includes use of smartphones and wearables to collect data in real time during day-to-day life (remote measurement technologies, RMT). Such data could capture changes relevant to depression for use in objective screening, symptom management and relapse prevention. This approach may be particularly accessible to young people of today as the smartphone generation. However, there is limited research on how such a complex intervention would work in the real world. We conducted a collaborative realist review of RMT for depression in young people. Here we describe how, why, for whom and in what contexts RMT appear to work or not work for depression in young people and make recommendations for future research and practice. Ethical, data protection and methodological issues need to be resolved and standardized; without this, RMT may be currently best used for self-monitoring and feedback to the healthcare professional where possible, to increase emotional self-awareness, enhance the therapeutic relationship and monitor the effectiveness of other interventions.
... Along those same lines, mental health apps are designed to improve mental health and well-being among their users [14][15][16]. These apps can be designed to address specific mental health disorders [17,18], or they can be more general, focusing on promoting mental health and preventing mental distress through a variety of tools and resources such as emotional self-monitoring and coping strategies [19,20]. ...
Background
Adolescence is a critical time in which many psychological disorders develop. Mental health promotion is important, especially during this period. In recent years, an increasing number of mobile apps geared toward mental health promotion and preventing mental illness have been developed specifically for adolescents, with the goal of strengthening their mental health and well-being.
Objective
This study aims to explore adolescents’ attitudes toward mental health apps, as well as the perceived usefulness of mental health apps.
Methods
In this mixed methods study, a total of 183 adolescents (mean age 15.62, SD 3.21 years) answered a cross-sectional questionnaire, with 10 questions (eg, “What do you think about mental health apps in general?”). To complement the quantitative findings, individual interviews were conducted with 9 adolescents, during which they could elaborate on their opinions about mental health apps.
Results
A total of 30% (56/183) of the adolescents in the quantitative study had used a mental health app. Over half of the respondents (77/126, 61.1%) reported that they would use a mental health app if they had a mental health problem as well as that they thought mental health apps were somewhat or very useful (114/183, 62.3%). Availability was the most frequently reported advantage of mental health apps (107/183, 58.8%). Possible associated costs of mental health apps were the most frequently mentioned barrier to their use (87/183, 47.5%). Findings from the interviews also pointed to the importance of the availability of mental health apps as well as their credibility and potential to provide adolescents with autonomy when seeking mental health advice and help.
Conclusions
Overall, the results indicate that adolescents have a positive attitude toward and an interest in mental health apps. However, adolescents are also more or less unaware of such apps, which might be one reason why they are often not used. The findings of this study have important implications for future research on mental health apps and for developers of mental health apps that target young people. The insights gained from this study can inform the development of more effective mental health apps that better meet the needs and preferences of adolescents.
... Additionally, two reports each provided data for two independent samples (Flett et al., 2020;O'Dea et al., 2020). A manual search of the reference lists of 17 reviews on mHealth for young people identified three additional reports (Kenny et al., 2015;Paul & Fleming, 2019;Pisani et al., 2018). The final sample therefore comprised 15 independent samples, sourced from 13 independent studies and interventions. ...
... wide CIs) were associated with the three smallest samples (Kageyama et al., 2021;Lim et al., 2019;Paul & Fleming, 2019). Although Flett et al., (2020, sample B) and Kenny et al. (2015) reported attrition rates as high as 57% for their respective app interventions, these values were not significantly different from the population rate (p > 0.05). ...
Psychological interventions provided via mobile, wireless technological communication devices (mHealth) are a promising method of healthcare delivery for young people. However, high attrition is increasingly recognised as a challenge to accurately interpreting and implementing the findings of mHealth trials. The present meta-analysis consolidates this research and investigates potential methodological, sociodemographic, and intervention moderators of attrition. A systematic search of MEDLINE, PsycInfo, and Embase was conducted. Study reporting quality was evaluated (QualSyst tool), and attrition rates (proportions) were calculated and pooled, using both random- and mixed-effects models. The pooled attrition rate, sourced from 15 independent samples (Nparticipants = 1766), was 17% (CI [9.14, 30.13]). This increased to 26% (CI [15.20, 41.03]) when adjusting for publication bias. Attrition was significantly higher among application-based interventions (26%, CI [14.56, 41.86]) compared to those delivered via text or multimedia message (6%, CI [1.88, 16.98]). These data were, however, characterised by significant between-study variance. Attrition in mHealth trials with young people is common but may be mitigated by using message-based interventions. Taken together, the results can provide guidance in accounting for attrition across future mHealth research, clinical practice, public policy, and intervention design. However, sustained research focus on the effectiveness of different engagement strategies is needed to realise mHealth’s promise of equitable and efficient healthcare access for young people globally.
... Young people reflected on the effectiveness of DHP for supporting behavior change and increasing confidence in their health choices (54%). Receiving feedback on one's progress, and recognition of improved personal health behaviors after engagement with health promotion technology, were mentioned as positive aspects [41,44,[67][68][69][70][71]. Finally, DHP technology offered young people the benefit of privacy and confidentiality (36%), allowing users to be open and honest about matters of health, and reducing the need to engage with a healthcare professional face to face [38,68,70,72,73]. ...
... Receiving feedback on one's progress, and recognition of improved personal health behaviors after engagement with health promotion technology, were mentioned as positive aspects [41,44,[67][68][69][70][71]. Finally, DHP technology offered young people the benefit of privacy and confidentiality (36%), allowing users to be open and honest about matters of health, and reducing the need to engage with a healthcare professional face to face [38,68,70,72,73]. ...
Background
As digital technology presents the potential to enhance the accessibility and effectiveness of health promotion campaigns, adolescents and young adults are an important target population. Young people are establishing behaviors that will contribute to the quality of their health later in life, and thus understanding their particular perspectives and receptivity to digital technologies for health promotion is crucial. With this review we aimed to synthesize the published literature reporting perspectives on digital health promotion (DHP) from adolescents and young adults worldwide.
Methods
We conducted a scoping review of the literature on five research databases. We included papers which defined a target population of young people, and encompassed qualitative, quantitative, and mixed methods studies. Two independent reviewers thematically analyzed the included publications and provided both a quantitative and a narrative synthesis of the views of youth (namely opportunities and concerns) on digital health promotion.
Results
We retrieved and analyzed 50 studies which met our inclusion and exclusion criteria. The large majority of these studies were conducted in high-income countries, while only a few collected the perspectives of youth in low- or middle-income countries. Findings revealed the importance of certain technology features, such as user interface design, as well as the significance of lack of personalization or user experience friction, for example, as deterrents to engagement with DHP tools. Ethically relevant aspects, such as those related to privacy or scientific reliability of the tools, did not receive much attention from youth. Yet, DHP for particularly sensitive areas of health elicited more frequent concerns about data security and evidence of effectiveness.
Conclusions
Young people express distinct opinions and preferences concerning the use of digital technologies for health promotion. Our review identified a general appreciation and receptivity on the part of adolescents and young adults towards these technologies, even when taking potential risks into account.
... While some students reported being stymied by the unfamiliarity of the technology it appears that many discovered new digital abilities in software product conceptualisation and design. This is important given that the world of smartphone technology has revolutionised the field of adolescent mental health work which is often categorised by adolescent resistance to engage in traditional mental health practices as well as being cost effective (Kenny, Dooley & Fitzgerald, 2015). With further technology developments, it may be possible to include new interfaces with smartphones such as video that can connect users with their therapists (Luxton, McCann, Bush, Mishkind, & Reger, 2011). ...
