Yvette Roke’s research while affiliated with GGZ Centraal and other places

UNSTRUCTURED Digital mental health solutions have great potential to enhance mental healthcare. However, barriers at the level of users, interventions and context hinder engagement and uptake. Involving users in the design, adaptation and implementation process has been put forward as a potential solution, yet instructions and examples on how to do so are limited. One potential framework is design thinking. Although design thinking is a common approach in the business community, its use for guiding development and adaptation processes is not yet common practice in the context of digital mental health. Unsurprisingly, it is difficult to find concrete instructions on how to do this, even more so in an international context. Therefore, the Successful User Participation Examples and Recommendations (SUPER) project aimed to develop guidelines for entrepreneurs and mental health organizations on how to involve end-users and mental health professionals in the transnational development, implementation and adaptation of mental health technology. This paper describes the steps of design thinking and how these can be undertaken by researchers, practitioners or developers in the context of digital mental health. The process is illustrated with two adaptations of digital mental health solutions following this approach, executed by the SUPER consortium in the Netherlands and in Denmark. The learnings from these two pilots are provided in the form of key considerations and highlights of issues that were experienced during both design thinking processes. The overall aim is to guide practitioners, developers and researchers towards better development and international adaptation of digital mental health.

Increased user participation in developing and adapting digital mental health solutions helps to tackle barriers and enhance facilitators for uptake of and engagement with digital mental health solutions. These guideline aims to aid this process of involving and empowering the intended users and provide a practical step-by-step guide to better understand and include them in a meaningful way. To do so, we will elaborate on the importance and concept of this participation. Then, we will present Design Thinking as a process framework, referring to methods you can use for user participation throughout the process. To provide depth, the guidelines incorporate insights from transnational adaptations of two digital mental health solutions: the Stress Autism Mate (SAM) app and the SAFE app. These real-world examples highlight the challenges and successes encountered when scaling solutions across cultural contexts. Finally, we summarise our recommendations in concrete topics you should be aware of when working with user participation for digital mental health innovation in an international context.

Objective Studies indicate that stress levels of autistic adolescents may be particularly high. Therefore, support is needed to help them deal with their stressors. Stress Autism Mate (SAM) Junior, a mobile self-help tool, was designed in co-creation with adolescents with autism to help reduce daily stress levels. The app is based on the SAM app, which was previously shown to be effective in reducing stress in autistic adults. This study aimed to evaluate the effectiveness of the SAM Junior app in reducing perceived stress and maladaptive coping styles, and increasing adaptive coping styles and quality of life in adolescents with autism. Methods A total of 24 Dutch adolescents with autism participated in this Single Case Experimental Design study. Sixteen of them (9 girls and 7 boys; Mage = 15.0 years, SD = 1.9) completed all research phases. Data were collected at four time points separated by four weeks: Control, pre-test, post-test and follow-up. Linear mixed-effects models were used to analyze the data. Results At post-test, use of the SAM Junior app had no significant effects on participants’ perceived stress (B = 0.31; 95% CI [-1.59, 2.22], p = .73), adaptive coping (B = -1.38; 95% CI [-5.69, 2.94], p = .51), maladaptive coping (B = -0.63; 95% CI [-4.56, 3.30], p = .74) and quality of life (B = -4.13; 95% CI [-12.19, 3.94], p = .29). These non-significant effects persisted at follow-up. Discussion Current preliminary results do not show effectiveness of the SAM Junior app to support adolescents with autism. Using the app as intended, without professional supervision, may have been too complex for this population. Further research is needed to determine the potential effects of the SAM Junior app with more certainty.

Introduction The mobile health application “Stress Autism Mate” (SAM) was designed to support adults with autism in identifying and managing daily stress. SAM measures stress four times daily, provides a daily and weekly stress overview, and provides personalised stress reduction advice. This study aimed to assess the effectiveness of SAM over four weeks in reducing perceived stress and internalised stigma, and enhancing coping self-efficacy, quality of life, and resilience among adults with autism. Methods Using an A1-B-A2 single-case experimental design, the effect of using SAM on adults with autism was assessed. The phases consisted of A1; treatment as usual (TAU), B; introducing SAM, and finally A2; follow-up with TAU and without the use of SAM. Each phase lasted four weeks, and data were collected via questionnaires before and after each phase. Linear mixed models were used for data analysis. Results Results show significant reductions in perceived stress levels, increased coping self-efficacy, and improved perceived health and psychological well-being after using SAM. Furthermore, increased resilience, and decreased internalised stigma were reported after follow-up. Discussion In conclusion, this study highlights SAM as a valuable tool for empowering adults with autism to reduce stress and internalised stigmaand to improve coping self-efficacy, psychological well-being, and resilience.

Background: Work-related stress and burnout remain common problems among employees, leading to impaired health and higher absenteeism. The use of mobile health apps to promote well-being has grown substantially; however, the impact of such apps on reducing stress and preventing burnout is limited. Objective: This study aims to assess the effectiveness of STAPP@Work, a mobile-based stress management intervention, on perceived stress, coping self-efficacy, and the level of burnout among mental health employees. Methods: The study used a single-case experimental design to examine the use of STAPP@Work among mental health employees without a known diagnosis of burnout (N=63). Participants used the app for 1 week per month repeatedly for a period of 6 months. Using a reversal design, the participants used the app 6 times to assess replicated immediate (1 week after use) and lasting (3 weeks after use) effects. The Perceived Stress Scale, the Coping Self-Efficacy Scale, and the Burnout Assessment Tool were used to measure the outcomes. Linear mixed models were used to analyze the data. Results: After 6 months of app use for 1 week per month, the participants showed a statistically significant decrease in perceived stress (b=–0.38, 95% CI –0.67 to –0.09; P=.01; Cohen d=0.50) and burnout symptoms (b=–0.31, 95% CI –0.51 to –0.12; P=.002; Cohen d=0.63) as well as a statistically significant improvement in problem-focused coping self-efficacy (b=0.42, 95% CI 0-0.85; P=.049; Cohen d=0.42). Long-term use of the app provided consistent reductions in burnout symptoms over time, including in the level of exhaustion and emotional impairment. Conclusions: The use of an app-based stress management intervention has been shown to reduce burnout symptoms and enhance coping self-efficacy among mental health workers. Prevention of burnout and minimization of work-related stress are of utmost importance to protect employee health and reduce absenteeism.

BACKGROUND Work-related stress and burnout remain a common problem among employees leading to impaired health and higher absenteeism. Use of mobile health apps to promote well-being has grown substantially, however, the impact of such apps on reducing stress and preventing burnout is limited. OBJECTIVE This study aimed to assess the effectiveness of STAPP@Work, a mobile based stress management intervention, on perceived stress, coping self-efficacy and the level of burnout among mental health employees. METHODS A study using a single-case experimental design was conducted among mental health employees without a known diagnosis of burnout (n=63). Participants have used the app one week per month repeatedly for a period of six months. Using a reversal design, the intervention was applied for a total of six times to assess replicated immediate (1-weeks post-use) and lasting (3-weeks post-use) effects. The Perceived Stress Scale, Coping Self-Efficacy Scale and Burnout Assessment Tool were used to measure outcomes. Linear mixed models were used to analyze the data. RESULTS After six months of app use for one week per month the participants showed a statistically significant decrease in perceived stress (b=-0.38, 95% CI -0.67 to -0.09; P=.01, d=0.50) and burnout symptoms (b=-0.31, 95% CI -0.51 to -0.08; P=.002, d=0.63) as well as a statistically significant improvement in problem-focused coping self-efficacy (b=0.42, 95% CI 0.00 to 0.85; P=.049, d=0.42). Long-term use of the app provided consistent and sustained reductions in burnout symptoms including the level of exhaustion and emotional impairment. CONCLUSIONS The findings indicate that introducing an app-based stress management intervention can be feasible and successfully implemented to reduce burnout symptoms and enhance coping self-efficacy.

Background Work-related stress and burnout remain common problems among employees, leading to impaired health and higher absenteeism. The use of mobile health apps to promote well-being has grown substantially; however, the impact of such apps on reducing stress and preventing burnout is limited. Objective This study aims to assess the effectiveness of STAPP@Work, a mobile-based stress management intervention, on perceived stress, coping self-efficacy, and the level of burnout among mental health employees. Methods The study used a single-case experimental design to examine the use of STAPP@Work among mental health employees without a known diagnosis of burnout (N=63). Participants used the app for 1 week per month repeatedly for a period of 6 months. Using a reversal design, the participants used the app 6 times to assess replicated immediate (1 week after use) and lasting (3 weeks after use) effects. The Perceived Stress Scale, the Coping Self-Efficacy Scale, and the Burnout Assessment Tool were used to measure the outcomes. Linear mixed models were used to analyze the data. Results After 6 months of app use for 1 week per month, the participants showed a statistically significant decrease in perceived stress (b=–0.38, 95% CI –0.67 to –0.09; P=.01; Cohen d=0.50) and burnout symptoms (b=–0.31, 95% CI –0.51 to –0.12; P=.002; Cohen d=0.63) as well as a statistically significant improvement in problem-focused coping self-efficacy (b=0.42, 95% CI 0-0.85; P=.049; Cohen d=0.42). Long-term use of the app provided consistent reductions in burnout symptoms over time, including in the level of exhaustion and emotional impairment. Conclusions The use of an app-based stress management intervention has been shown to reduce burnout symptoms and enhance coping self-efficacy among mental health workers. Prevention of burnout and minimization of work-related stress are of utmost importance to protect employee health and reduce absenteeism.

Objectives Adults with autism often need support to detect their stress and to apply adequate coping strategies for dealing with daily stress. The personalized mobile application Stress Autism Mate (SAM) is developed for and by adults with autism to detect and cope with daily life stress. SAM measures stress four times daily, generates an overview of the patients’ stress level and gives personalized advice to reduce stress. Methods With a pre-to post-treatment design, the level of perceived stress, coping self-efficacy and self-rated quality of life (QoL) was assessed at baseline (pre-test), after the four-week intervention (post-test) and after eight-week follow-up. Data was analysed using multilevel analysis taking within subject variance into account. Results At post-test measurement, there was a significant decrease in perceived stress. At post-test as well as follow-up, a significant improvement in coping self-efficacy and improvement in self-rated QoL was seen. Conclusions The results of this pilot study suggest that the personalized mHealth tool SAM can support adults with autism in detecting stress, improving their stress coping skills and improving their self-rated quality of life. In practice, SAM can be seen as an external stress monitor that can easily be integrated in the lives of adults with autism, to detect and cope with stress.