The Use of Mobile Apps and SMS Messaging as Physical and Mental Health Interventions: Systematic Review.

BACKGROUND: The initial introduction of the World Wide Web in 1990 brought around the biggest change in information acquisition. Due to the abundance of devices and ease of access they subsequently allow, the utility of mobile health (mHealth) has never been more endemic. A substantial amount of interactive and psychoeducational apps are readily available to download concerning a wide range of health issues. mHealth has the potential to reduce waiting times for appointments; eradicate the need to meet in person with a clinician, successively diminishing the workload of mental health professionals; be more cost effective to practices; and encourage self-care tactics. Previous research has given valid evidence with empirical studies proving the effectiveness of physical and mental health interventions using mobile apps. Alongside apps, there is evidence to show that receiving short message service (SMS) messages, which entail psychoeducation, medication reminders, and links to useful informative Web pages can also be advantageous to a patient's mental and physical well-being. Available mHealth apps and SMS services and their ever improving quality necessitates a systematic review in the area in reference to reduction of symptomology, adherence to intervention, and usability. OBJECTIVE: The aim of this review was to study the efficacy, usability, and feasibility of mobile apps and SMS messages as mHealth interventions for self-guided care. METHODS: A systematic literature search was carried out in JMIR, PubMed, PsychINFO, PsychARTICLES, Google Scholar, MEDLINE, and SAGE. The search spanned from January 2008 to January 2017. The primary outcome measures consisted of weight management, (pregnancy) smoking cessation, medication adherence, depression, anxiety and stress. Where possible, adherence, feasibility, and usability outcomes of the apps or SMS services were evaluated. Between-group and within-group effect sizes (Cohen d) for the mHealth intervention method group were determined. RESULTS: A total of 27 studies, inclusive of 4658 participants were reviewed. The papers included randomized controlled trials (RCTs) (n=19), within-group studies (n=7), and 1 within-group study with qualitative aspect. Studies show improvement in physical health and significant reductions of anxiety, stress, and depression. Within-group and between-group effect sizes ranged from 0.05-3.37 (immediately posttest), 0.05-3.25 (1-month follow-up), 0.08-3.08 (2-month follow-up), 0.00-3.10 (3-month follow-up), and 0.02-0.27 (6-month follow-up). Usability and feasibility of mHealth interventions, where reported, also gave promising, significant results. CONCLUSIONS: The review shows the promising and emerging efficacy of using mobile apps and SMS text messaging as mHealth interventions.

Assessing the Efficacy of Mobile Health Apps Using the Basic Principles of Cognitive Behavioral Therapy: Systematic Review.

BACKGROUND: Cognitive behavioral therapy (CBT) in its basic principle has developed itself as a stand-alone, substantial method of therapy. With effective application in therapy for a range of mental health issues, the spread of CBT methods to Web-based therapy sources is evident. The development of mobile phone apps using CBT principles is increasing within the research area. Despite the move to Web-based methods of therapy, it is argued that these methods lack the same efficacy of face-to-face therapy sessions. OBJECTIVE: The aim of this review was to assess extent research findings with regard to the effectiveness of CBT-related mobile health (mHealth) apps. By assessing only studies employing a randomized controlled trial design, the review aimed to determine app efficacy within the highly regarded method of investigation. METHODS: A comprehensive literature search was conducted across several databases. Search results were filtered, and results were subject to strict inclusion and exclusion criteria because of the nature of the review. Where possible, analysis of effect size was calculated and results reported. RESULTS: A total of 8 studies investigating the effectiveness of mHealth CBT-related apps across a range of mental health issues were reviewed. Three studies used the app against a control group, and 5 studies used the app intervention against another form of treatment or intervention. A range of effect sizes were seen across all included studies (d=-0.13 to 1.83; 0.03-1.44), with the largest effects often being seen when comparing the data from pre- to posttest for the app engaged group. CONCLUSIONS: The studies reviewed support the use of mHealth apps containing CBT principles for a range of mental health issues. However, the effectiveness over longer time periods should be assessed. Researchers and professionals should seek to collaborate effectively when creating new apps to enhance their effectiveness as a treatment for the general public.

Supporting parents with acutely ill children: Environment scan and user evaluation of mobile applications (the SuPa kids project).

BACKGROUND: Children are one of the biggest users of emergency departments in the UK, sometimes utilising services when experiencing acute illnesses that can be managed at home. mHealth can be an efficacious way for parents/guardians to manage acute illnesses. It has also become a ubiquitous resource to promote public health interests within a resource constrained health system. However, to be effective, co-design is necessary with concepts such as usefulness, ease of use, trustworthiness and security underpinning the utility of mHealth interventions for acute childhood illness. OBJECTIVE: The objective of this study was to conduct an environmental scan of mHealth apps for parental assessment and management of acute childhood illnesses in 0- to 5-year-olds, review the content and functionality of each identified app against the list of desired attributes identified in previous research and synthesise publicly available reviews from end users to demonstrate the quality of current apps in the marketplace and identify areas for improvement. METHOD: App characteristics were mapped to an a priori defined list of desirable attributes. End user reviews were mapped to a modified Technology Acceptance Model framework that included overarching themes of: Perceived Usefulness (PU), Perceived Ease of Use (PEU), Perceived Trustworthiness (PT) and Perceived Security (PS) using reflexive thematic analysis. RESULTS: Overall, 15 apps were included in the analysis (Table 2). Fourteen of the 15 apps were available on both the iOS and Android platforms. 'Baby Illness, Prevention, Cure' was only available on the Android store. All apps were free to download and did not restrict access to information or features via in-app purchases. Baby and child first aid (British Red Cross) was the earliest app to be released (2014). This app was updated annually, with the most recent update being 2022. The most recent apps to be released (2018) were 'AskFirst' (formerly Ask NHS), 'Essex Child Health' and 'The Lullaby Trust Baby Check', updated in 2022, 2020 and 2019, respectively. No individual app met all the desirable attributes highlighted by parents in previous research. Both 'Healthier Together', and 'The Lullaby Trust Baby Check' included all but one desirable attributes (video), as did the ''CATCH (Common Approach to Children's Health), which did not utilise a traffic light system. Apps that were locality specific were not rated by users (Berkshire Child Health, Cheshire Child Health, Child Health Guide Newham, Child Health HMR, Oldham Child Illness and Walsall Healthy Child). All other apps were rated from 2/5 to 5/5 stars. When considering localities, the 'CATCH' app was only supported in Halton, Cheshire, Knowsley, Liverpool, St Helens and Vale Royal. Further investigation evidenced no correlation between inclusion of the desirable attributes and app rating. CONCLUSION: Overall, this research has highlighted several aspects of best practise when developing mHealth apps for the management of acute childhood illnesses, for increasing PU, PEU, PT and PS; and also, places importance on co-design.

People with long-term conditions sharing personal health data via digital health technologies: A scoping review to inform design.

The use of digital technology amongst people living with a range of long-term health conditions to support self-management has increased dramatically. More recently, digital health technologies to share and exchange personal health data with others have been investigated. Sharing personal health data with others is not without its risks: sharing data creates threats to the privacy and security of personal data and plays a role in trust, adoption and continued use of digital health technology. Our work aims to inform the design of these digital health technologies by investigating the reported intentions of sharing health data with others, the associated user experiences when using these digital health technologies and the trust, identity, privacy and security (TIPS) considerations for designing digital health technologies that support the trusted sharing of personal health data to support the self-management of long-term health conditions. To address these aims, we conducted a scoping review, analysing over 12,000 papers in the area of digital health technologies. We conducted a reflexive thematic analysis of 17 papers that described digital health technologies that support sharing of personal health data, and extracted design implications that could enhance the future development of trusted, private and secure digital health technologies.

Online peer to peer support: Qualitative analysis of UK and US open mental health Facebook groups.

OBJECTIVE: This research aimed to gain further understanding of how open Facebook groups are used for online peer to peer support and identify any similarities and/or differences between UK and US groups. METHOD: A systematic search of mental health related open Facebook groups was conducted using relevant key words. The posts from 14 UK and 11 US groups were acquired over a three month period and content thematically analysed using Nvivo. RESULTS: Findings support previous research which evidences that online peer to peer support is beneficial for users seeking mental health information. Said support can increase feelings of connectedness, reduce feelings of isolation, and provide a platform for comparison of perspectives relating to personal experiences. Group membership may offer hope and increase feelings of empowerment in those using Facebook groups as a support mechanism. There was similar discourse seen throughout both UK and US posts in regards to gender inequality, lack of awareness and stigmatisation. CONCLUSIONS: The study highlights the positive impact of shared personal experiences, and offers a greater understanding of the benefits of online peer to peer support for mental health and wellbeing. There is evidence that, whilst mental health is becoming a more widely discussed topic, in both the UK and US, it remains negatively perceived. Questions are posed for group administrators and health professionals relating to their utilisation and moderation of such online peer to peer support networks.

"I Feel Like A Neurotic Mother at Times"-a mixed methods study exploring online health information seeking behaviour in new parents.

BACKGROUND: In contemporary society, due to the exponential growth of technology and the online platform, data acquisition has never been so effortless. Subsequent accessibility to health information has been reported as having many positive and negative effects. Health anxiety is the apprehension of experiencing or developing an ailment due to symptomology misinterpretation. One such lifetime occurrence which causes increased anxiety is becoming a new parent. New parents often use the online platform to seek information which will educate them on how best to care for their child and to keep their child's health at the optimum level. METHODS: The online Pregnancy Questionnaire used within this study was inclusive of the Short HAI Health Anxiety Inventory (HAI) and was tailored for both pregnant women and new parents. This study focuses specifically on the results provided by the new parents. The research was disseminated and advertised on social media platforms such as Facebook, Twitter and a purpose-built website named "A Healthy Search" which provided all information relevant to the study and participation. Quantitative data were analysed using a regression and qualitative data were thematically analysed. RESULTS: Results shows that medical complications in pregnancy did not significantly predict health anxiety however medical care within the past year did. It can also be seen that frequency of searching online for self, did not significantly predict health anxiety, yet searching online for child did significantly predict health anxiety. Anxiety specific to pregnancy ceases when gravidity comes to an end and feelings of health anxiety then tend to be transferred from the mother (parent) to the child when one becomes a new parent. New parents strive to expand their own knowledge base, in regards to typical and atypical symptomology, so that they are better equipped to monitor development, care for, and make decisions on behalf of their child. The online platform was used as opposed to offline provisos due to inexperience, judgement and anonymity. Online health information seeking behaviour also has the probability of both increasing and decreasing levels of anxiety in new parents. CONCLUSIONS: This research recognised and reinforced positive and negative aspects of online health information seeking behaviour. It is recommended that further research be carried out into relevant, efficacious interventional techniques that may relieve health anxiety within new parents as contemporary technology has become a pivotal aspect of life.

The Use of Mobile Apps and SMS Messaging as Physical and Mental Health Interventions: Systematic Review.

(Reprinted with permission from J Med Internet Res 2017; 19(8):e295).

Predictors of health anxiety during pregnancy.

BACKGROUND: The internet has become a quick, easy and accessible source for health-related information. Women are more likely to search for health information online and this likelihood increases further during pregnancy. Searching online for health-related information can have both positive and negative impacts upon levels of health anxiety during pregnancy. This research initially explored how health impacts heath anxiety during pregnancy. Secondly, the sources of offline support that predict health anxiety and thirdly, how online health seeking behaviour predicts health anxiety. METHODS: The sample consisted of 159 pregnant women who completed an online questionnaire to investigate significant predictors of health anxiety during pregnancy. RESULTS: Multiple regression analyses showed health anxiety increased during pregnancy when medical complications had been experienced in a previous pregnancy and if under medical treatment for a non-pregnancy related condition. Interestingly, health anxiety was not affected by medical complications in the current pregnancy. Knowing when you have had enough information and repeating searches were significant predictors of levels of health anxiety, whereas using the same or different sources was not. CONCLUSIONS: For many the internet is a convenient platform for information however the information is not always accurate, reliable or helpful. Relevant health care professionals should continue to sign-post pregnant women to validated health information websites with the aim to reassure women during pregnancy. Further research in this area would benefit from exploring how women use the internet when pregnant and devising guidelines which can be followed and recommended when doing so.