Exploring the views of adolescents with type 1 diabetes on digital mental health interventions: What functionality and content do they want?

BACKGROUND: Adolescents with type 1 diabetes (T1D) experience higher rates of psychological disorders compared with their healthy peers. As poor psychological health has been associated with suboptimal glycaemic control and more frequent complications, there is an urgent need to develop more 'clinically usable' interventions. Digital mental health interventions offer unique advantages compared with in-person interventions; however, what adolescents with T1D want in terms of content and functionality is poorly understood. Accordingly, the current study conducted focus groups to examine the views of adolescents with T1D regarding digital mental health interventions. METHODS: Four focus groups were conducted, including 16 adolescents with T1D, ranging from 13 to 17 years in age (69% female). Transcripts were analysed using directed content analysis to examine (1) 'what adolescents dislike about existing digital mental health interventions?' and (2) 'what adolescents want in future digital mental health interventions?'. RESULTS: Findings provide a preliminary understanding of what adolescents dislike and also the type of content and functional features, which may be important to include in digital mental health programs for this population, such as a peer support feature (reported by 16 of 16), emotion and diabetes check-in feature (11 of 16) and diabetes-relevant content (12 of 16). CONCLUSIONS: Early data suggest that digital mental health interventions should include a significant peer support element, diabetes-relevant content and examples, and check-in on their mental health and diabetes self-management regularly, while avoiding fixed responses or modules and non-age-appropriate content. Based on these findings, a digital intervention is currently being developed.

Self-compassion in weight management: A systematic review.

OBJECTIVE: Self-compassion - the tendency or ability to treat oneself kindly in times of failure or distress - may be a natural fit to support individuals who struggle with weight management. However, while self-compassion shows promise with improving health behaviours, the associations self-compassion has on weight management outcomes are unclear. The objective of this systematic review was three-fold: (1) to evaluate whether self-compassion interventions can increase individual self-compassion in the context of weight management, (2) to investigate if self-compassion interventions can improve weight management outcomes, defined as healthier eating, increased physical activity, or reduced weight and finally, (3) to explore whether these benefits can be sustained over the longer term. METHODS: Following PRISMA guidelines, Scopus, PsycINFO, Medline, PubMed and Embase databases were searched. Studies including a measure of self-compassion and a self-compassion intervention reporting weight management outcomes were included. Studies in populations living with an eating disorder were excluded. The Quality Criteria Checklist from the American Dietetic Association was used to assess study quality. Prospero Registration #CRD42019146707. RESULTS: Of the 9082 records screened, a total of 20 studies met inclusion criteria. Seventeen studies reported significant increases in self-compassion post-intervention. Improvements were also found for eating behaviours (15 of 18), physical activity behaviours (6 of 9), and weight loss (6 of 11). The majority of improvements were maintained at follow-up, except for physical activity behaviours (1 of 7). CONCLUSION: Self-compassion interventions tailored to weight management outcomes demonstrate efficacy with increasing self-compassion post-intervention. Methodological weaknesses and questions about the maintenance of any improvements in weight management outcomes limit our ability to make strong conclusions. However, there is promise and clear relevance for including self-compassion interventions to enhance weight management outcomes; directions for improved intervention and study design are given.

Pilot study of a well-being app to support New Zealand young people during the COVID-19 pandemic.

BACKGROUND: Well-being apps represent a promising and scalable approach for improving mental health outcomes in youth, especially during a global pandemic when access to face-to-face interventions may be limited. Whitu (meaning 7 in the New Zealand Maori language Te Reo) is a newly developed well-being app with 7 modules that support young people to learn and practice evidence-based coping skills, including relaxation, mindfulness, self-compassion, and goal-setting. OBJECTIVE: During this pilot, we explored the acceptability, usability, and preliminary efficacy of Whitu before refining the app for a randomized controlled trial (RCT). METHODS: We recruited 20 New Zealand young people aged 16-25 years via social media to trial the first prototype of the Whitu app over 6 weeks. Within-group differences from baseline to 2- and 6-weeks post intervention in self-reported well-being, depression, anxiety, stress, self-compassion, optimism and sleep quality were evaluated using repeated-measures ANOVA. A further 21 participants aged 16-30 years were recruited to participate in 4 focus groups to give feedback on the app's usability and cultural acceptability. Feedback was analysed using directed content analysis. RESULTS: Statistically significant improvements in anxiety (p = 0.024) and stress (p = 0.017) were observed from baseline to 2-weeks post intervention. Improvements in well-being (p = 0.021), depression (p = 0.031), anxiety (p = 0.005), and stress (p = 0.004) were also observed from baseline to 6-weeks. No statistically significant changes were seen in self-compassion, optimism, or sleep quality. Effect sizes (partial η2s) ranged from 0.25 (depression) to 0.42 (stress). Qualitative feedback comprised of five key themes, namely: factors affecting engagement, issues with functionality, preferences regarding aesthetics, effectiveness and adverse effects, and cultural acceptability. CONCLUSIONS: Our preliminary results suggest that Whitu may be an effective app for improving multiple dimensions of young people's well-being. Modifications to the look and feel, cultural content, and onboarding have been undertaken based on the qualitative feedback, and an RCT is currently underway.

Coping Skills Mobile App to Support the Emotional Well-Being of Young People During the COVID-19 Pandemic: Protocol for a Mixed Methods Study.

BACKGROUND: The COVID-19 pandemic is likely to increase anxiety and distress in young people worldwide. It is important to prioritize mental health during crisis events to mitigate the negative and often long-term effects of the crises on young people, families, and society. Mental health and well-being apps represent a scalable approach for improving psychological outcomes in young people and have potential to improve the equity of service access. OBJECTIVE: The Whitu: 7 Ways in 7 Days well-being app was recently developed by our group to address the urgent need for innovative approaches to reach young New Zealanders who are struggling to cope with the COVID-19 pandemic. The aim of this study is twofold: to evaluate the acceptability of the prototype app and to examine the effectiveness of the refined app at improving mental and emotional well-being and reducing depression, anxiety, and stress in young people in New Zealand. METHODS: A two-phase mixed methods study will be undertaken to achieve these aims. During the first phase, 20 young people aged 16-30 years (including those of Maori and Pacific ethnicity) will participate in a qualitative study to help refine the prototype app. During the second phase, 90 young people aged 16-30 years will participate in a randomized waitlist-controlled trial (RCT) to evaluate the efficacy of the refined Whitu app at 4 weeks and 3 months after baseline. Outcomes will be evaluated using validated web-based questionnaires at baseline, 4 weeks, and 3 months. RESULTS: The study received ethics approval in May 2020, and recruitment for the focus groups commenced in June 2020. Recruitment for the RCT is expected to commence in October 2020. Participants for both study phases will be recruited via social media and web-based communities. Data collection for the RCT is expected to be completed by January 2021, and analyses are expected to be completed by March 2021. Linear mixed modelling will be used to determine between-group differences in psychological outcomes. CONCLUSIONS: There is an urgent need to develop culturally appropriate, scalable mental health interventions to address the psychological consequences of the COVID-19 pandemic. In this study, we will develop and test an evidence-based well-being app that, if effective, can be made available to all young people in New Zealand and internationally. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12620000516987); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379597. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/23716.