TY - JOUR AU - Wang, Liwei AU - Ren, Jiajia AU - Zhang, Song AU - Sun, Yu?e AU - Ding, Yu AU - Yang, Congxian AU - Zheng, Chan AU - Shi, Zhenduo AU - Zhu, Yangzi PY - 2025/4/22 TI - Intrinsic Motivation, Attitudes, and Practices of Young Physicians Regarding Scientific Research: Cross-Sectional Study in China JO - J Med Internet Res SP - e72633 VL - 27 KW - intrinsic motivation KW - attitude KW - practice KW - scientific research KW - young physicians KW - cross-sectional study N2 - Background: Recent decades have witnessed a concerning global trend of declining engagement among physician scientists, with participation rates falling from 4.7% in the 1980s to approximately 1.5% today in the United States. The research highlights the declining engagement of physician scientists and the challenges young physicians face in participating in clinical research. Objective: This study aims to examine the intrinsic motivation, attitudes, and practices of young physicians toward scientific research and its clinical value and identify factors that influence their engagement in research activities. Methods: We developed a comprehensive questionnaire measuring intrinsic motivation (27 items; score range 27-135), attitudes (8 items; score range 8-40), and practices (7 items; score range 7-35) related to scientific research among physicians. Cronbach ? coefficients for the 3 dimensions were 0.967, 0.916, and 0.937, respectively. A cross-sectional survey was conducted on young physicians from 12 hospitals in eastern provinces of China between May 2024 and October 2024. Results: A total of 532 valid questionnaires were obtained. Among the respondents, 271 (50.9%) were female, and 317 (59.6%) had not led or been deeply involved in a research project. Most physicians (more than 80%) reported high intrinsic motivation and positive attitudes, but relatively fewer demonstrated active research practices. Key challenges identified included balancing research with clinical work (n=102, 19.2%) disagreed that research alleviates clinical monotony) and insufficient institutional support (n=329, 61.3%) reported inadequate research investment from their hospitals). The mean scores for intrinsic motivation, attitude, and practice were 108.79 (SD 11.91; possible range: 27-135), 32.23 (SD 4.27; possible range: 8-40), and 27.44 (SD 3.81; possible range: 7-35), respectively. Multivariate logistic regression showed that intrinsic motivation score (odds ratio [OR] 1.063, 95% CI 1.035-1.091), attitude score (OR 1.095, 95% CI 1.029-1.165), and good research atmosphere (OR 1.915, 95% CI 1.038-3.533) were independently associated with practice. Moreover, structural equation modeling analysis revealed that intrinsic motivation had a direct effect on attitude (?=0.854; P<.001), attitude directly affected practice (?=0.637; P<.001), and intrinsic motivation indirectly influenced practice through attitude (?=0.544; P<.001). Conclusions: Despite high levels of intrinsic motivation and positive attitudes toward research, young physicians face significant barriers to active research engagement. Our findings suggest that fostering a supportive research environment is a critical factor that can help translate motivation into practice. Young physicians exhibited positive intrinsic motivation and attitudes but relatively inactive practices toward scientific research and its clinical application. Institutional initiatives should focus on providing protected research time, formal mentorship programs, and adequate research infrastructure to leverage young physicians? existing motivation. Addressing the gap between motivation and practice could significantly contribute to reversing the declining trend of physician scientists and enhancing evidence-based medicine implementation. UR - https://www.jmir.org/2025/1/e72633 UR - http://dx.doi.org/10.2196/72633 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/72633 ER - TY - JOUR AU - Zhang, Zheyuan AU - Sun, Sijin AU - Moradbakhti, Laura AU - Hall, Andrew AU - Mougenot, Celine AU - Chen, Juan AU - Calvo, A. Rafael PY - 2025/4/4 TI - Health Care Professionals' Engagement With Digital Mental Health Interventions in the United Kingdom and China: Mixed Methods Study on Engagement Factors and Design Implications JO - JMIR Ment Health SP - e67190 VL - 12 KW - burnout KW - digital mental health interventions KW - engagement KW - eHealth KW - design KW - health care professional KW - health care workers KW - United Kingdom KW - UK KW - China KW - Chinese KW - occupational stress KW - mixed-methods KW - stigma KW - well-being KW - mental health KW - digital health KW - occupational health N2 - Background: Mental health issues like occupational stress and burnout, compounded with the after-effects of COVID-19, have affected health care professionals (HCPs) around the world. Digital mental health interventions (DMHIs) can be accessible and effective in supporting well-being among HCPs. However, low engagement rates of DMHIs are frequently reported, limiting the potential effectiveness. More evidence is needed to reveal the factors that impact HCPs? decision to adopt and engage with DMHIs. Objective: This study aims to explore HCPs? motivation to engage with DMHIs and identify key factors affecting their engagement. Amongst these, we include cultural factors impacting DMHI perception and engagement among HCPs. Methods: We used a mixed method approach, with a cross-sectional survey (n=438) and semistructured interviews (n=25) with HCPs from the United Kingdom and China. Participants were recruited from one major public hospital in each country. Results: Our results demonstrated a generally low engagement rate with DMHIs among HCPs from the 2 countries. Several key factors that affect DMHI engagement were identified, including belonging to underrepresented cultural and ethnic groups, limited mental health knowledge, low perceived need, lack of time, needs for relevance and personal-based support, and cultural elements like self-stigma. The results support recommendations for DMHIs for HCPs. Conclusions: Although DMHIs can be an ideal alternative mental health support for HCPs, engagement rates among HCPs in China and the United Kingdom are still low due to multiple factors and barriers. More research is needed to develop and evaluate tailored DMHIs with unique designs and content that HCPs can engage from various cultural backgrounds. UR - https://mental.jmir.org/2025/1/e67190 UR - http://dx.doi.org/10.2196/67190 ID - info:doi/10.2196/67190 ER - TY - JOUR AU - Cataldo, Francesco AU - Chang, Shanton AU - Mendoza, Antonette AU - Buchanan, George AU - Van Dam, Nicholas PY - 2025/4/1 TI - Exploring Technical Features to Enhance Control in Videoconferencing Psychotherapy: Quantitative Study on Clinicians? Perspectives JO - J Med Internet Res SP - e66904 VL - 27 KW - videoconference psychotherapy KW - control KW - therapeutic relationship KW - therapeutic alliance KW - videoconference technologies KW - technological features KW - video KW - telepsychiatry KW - videoconferencing KW - psychotherapy KW - mental health KW - mental KW - therapy KW - therapist KW - videoconference KW - platform KW - psychology KW - psychologist N2 - Background: The COVID-19 pandemic required psychologists and other mental health professionals to use videoconferencing platforms. Previous research has highlighted therapists? hesitation toward adopting the medium since they find it hard to establish control over videoconferencing psychotherapy (VCP). An earlier study provided a set of potential features that may help enhance psychologists? control in their videoconference sessions, such as screen control functionality, emergency call functionality, eye contact functionality, zooming in and out functionality, and an interactive interface with other apps and software. Objective: This study aims to investigate whether introducing technical features might improve clinicians? control over their video sessions. Additionally, it seeks to understand the role of the video in therapists? VCP experience from a technical and relationship point of view. Methods: A total of 121 mental health professionals responded to the survey, but only 86 participants provided complete data. Exploratory Factor Analysis was used to scrutinize the data collected. A total of three factors were identified: (1) ?challenges in providing VCP,? (2) ?features to enhance the therapeutic relationship,? and (3) ?enhancing control.? Path analysis was used to observe the relationship between factors on their own and with adjustment to participants? areas of expertise and year in practice. Results: This study highlighted a relationship between the three identified factors. It was found that introducing certain features reduced therapists' challenges in the provision of VCP. Moreover, the additional features provided therapists with enhanced control over their VCP sessions. A path analysis was conducted to investigate the relationships between the factors loaded. The results of the analysis revealed a significant relationship between ?challenges in VCP? and ?features to enhance the therapeutic relationship? (adjusted beta [Adj?]=?0.54, 95% CI 0.29-0.79; P<.001). Additionally, a significant positive relationship was found between ?features to enhance the therapeutic relationship? and ?enhancing control? (Adj?=0.25, 95% CI 0.15-0.35; P<.001). Furthermore, there was an indirect effect of ?challenges in providing VCP? on ?enhancing control? (Adj?=0.13, 95% CI 0.05-0.22; P=.001) mediated by ?features to enhance TR.? The analysis identified the factor ?features to enhance TR? (effect size=0.25) as key for improving clinicians? performance and control. Conclusions: This study demonstrates that technology may help improve therapists? VCP experiences by implementing features that respond to their need for enhanced control. By augmenting therapists? control, clinicians can effectively serve their patients and facilitate successful therapy outcomes. Moreover, this study confirms the video as a third agent that prevents therapists from affecting clients? reality due to technical and relational limits. Additionally, this study supports the general system theory, which allowed for the incorporation of video in our exploration and helped explain its agency in VCP. UR - https://www.jmir.org/2025/1/e66904 UR - http://dx.doi.org/10.2196/66904 UR - http://www.ncbi.nlm.nih.gov/pubmed/40168042 ID - info:doi/10.2196/66904 ER - TY - JOUR AU - Zhang, Xiaolong AU - Berry, Natalie AU - Di Basilio, Daniela AU - Richardson, Cara AU - Eisner, Emily AU - Bucci, Sandra PY - 2025/3/31 TI - Mental Health Professionals? Technology Usage and Attitudes Toward Digital Health for Psychosis: Comparative Cross-Sectional Survey Study JO - JMIR Ment Health SP - e68362 VL - 12 KW - digital mental health KW - psychosis KW - attitudes KW - implementation KW - smartphone app N2 - Background: Digital health technologies (DHTs) for psychosis have been developed and tested rapidly in recent years. However, research examining mental health professionals? views on the use of DHTs for people with psychosis is limited. Given the increased accessibility and availability of DHTs for psychosis, an up-to-date understanding of staff perception of DHTs for psychosis is warranted. Objective: In this study, we aimed to investigate mental health professionals? usage of technology and their perception of service users? technology usage; their views toward the use of DHTs for psychosis, including their concerns; and barriers for implementing DHTs in a mental health setting. Methods: Two cross-sectional surveys were distributed to mental health care staff who had experience of working with individuals experiencing psychosis in the United Kingdom. Survey 1 (from April 2018 to September 2020) was distributed to 3 local UK National Health Service (NHS) trusts in Northwest England; survey 2 was administered nationally across 31 UK NHS trusts or health boards (from November 2022 to March 2024). The COVID-19 pandemic occurred between the 2 survey periods. Data were analyzed descriptively. Results: A total of 155 and 352 participants completed surveys 1 and 2, respectively. Staff reported high levels of technology ownership and usage in both surveys. In general, staff expressed positive views regarding the use of DHTs for psychosis; however, barriers and concerns, including affordability, digital literacy, and potential negative effects on service users? mental health, were also reported. We did not find notable changes in terms of staff use of digital technology in clinical practice over time. Conclusions: Staff sampled from a broad and diverse range expressed consistent optimism about the potential implementation of DHTs in practice, though they also noted some concerns regarding safety and access. While the COVID-19 pandemic is frequently regarded as a catalyst for the adoption of digital health care tools, the sustainability of this transition from traditional to digital health care appeared to be suboptimal. To address staff concerns regarding safety and potentially facilitate the implementation of DHTs, systematic evaluation of adverse effects of using DHTs and dissemination of evidence are needed. Organizational support and training should be offered to staff to help address barriers and increase confidence in recommending and using DHTs with service users. UR - https://mental.jmir.org/2025/1/e68362 UR - http://dx.doi.org/10.2196/68362 ID - info:doi/10.2196/68362 ER - TY - JOUR AU - Shojaei, Fereshtehossadat AU - Shojaei, Fatemehalsadat AU - Osorio Torres, John AU - Shih, C. Patrick PY - 2024/12/4 TI - Insights From Art Therapists on Using AI-Generated Art in Art Therapy: Mixed Methods Study JO - JMIR Form Res SP - e63038 VL - 8 KW - art therapy KW - artificial intelligence KW - AI KW - therapeutic interventions KW - assistive AI KW - engagement KW - health care KW - therapy KW - art KW - therapists' insights KW - daily life KW - practitioner KW - assistive KW - AI-generated image KW - accessibility KW - therapy sessions KW - AI-generated tool N2 - Background: With the increasing integration of artificial intelligence (AI) into various aspects of daily life, there is a growing interest among designers and practitioners in incorporating AI into their fields. In health care domains like art therapy, AI is also becoming a subject of exploration. However, the use of AI in art therapy is still undergoing investigation, with its benefits and challenges being actively explored. Objective: This study aims to investigate the integration of AI into art therapy practices to comprehend its potential impact on therapeutic processes and outcomes. Specifically, the focus is on understanding the perspectives of art therapists regarding the use of AI-assisted tools in their practice with clients, as demonstrated through the presentation of our prototype consisting of a deck of cards with words covering various categories alongside an AI-generated image. Methods: Using a co-design approach, 10 art therapists affiliated with the American Art Therapy Association participated in this study. They engaged in individual interviews where they discussed their professional perspectives on integrating AI into their therapeutic approaches and evaluating the prototype. Qualitative analysis was conducted to derive themes and insights from these sessions. Results: The study began in August 2023, with data collection involving 10 participants taking place in October 2023. Our qualitative findings provide a comprehensive evaluation of the impact of AI on facilitating therapeutic processes. The combination of a deck of cards and the use of an AI-generated tool demonstrated an enhancement in the quality and accessibility of therapy sessions. However, challenges such as credibility and privacy concerns were also identified. Conclusions: The integration of AI into art therapy presents promising avenues for innovation and progress within the field. By gaining insights into the perspectives and experiences of art therapists, this study contributes knowledge for both practical application and further research. UR - https://formative.jmir.org/2024/1/e63038 UR - http://dx.doi.org/10.2196/63038 ID - info:doi/10.2196/63038 ER - TY - JOUR AU - Hildebrand, Sophie Anne AU - Planert, Jari AU - Machulska, Alla AU - Margraf, Maria Lena AU - Roesmann, Kati AU - Klucken, Tim PY - 2024/11/7 TI - Exploring Psychotherapists? Attitudes on Internet- and Mobile-Based Interventions in Germany: Thematic Analysis JO - JMIR Form Res SP - e51832 VL - 8 KW - eHealth KW - psychotherapy KW - psychotherapists? perspectives KW - thematic analysis KW - internet- and mobile-based intervention N2 - Background: In recent years, internet- and mobile-based interventions (IMIs) have become increasingly relevant in mental health care and have sparked societal debates. Psychotherapists? perspectives are essential for identifying potential opportunities for improvement, facilitating conditions, and barriers to the implementation of these interventions. Objective: This study aims to explore psychotherapists? perspectives on opportunities for improvement, facilitating conditions, and barriers to using IMIs. Methods: The study used a qualitative research design, utilizing open-ended items in a cross-sectional survey. A total of 350 psychotherapists were asked to provide their written opinions on various aspects of IMIs. Thematic analysis was conducted to analyze the data and identify core themes. Results: The analysis revealed 11 core themes related to the use of IMIs, which were categorized into 4 superordinate categories: ?Applicability,? ?Treatment Resources,? ?Technology,? and ?Perceived Risks and Barriers.? While many psychotherapists viewed IMIs as a valuable support for conventional psychotherapy, they expressed skepticism about using IMIs as a substitute. Several factors were perceived as hindrances to the applicability of IMIs in clinical practice, including technological issues, subjective concerns about potential data protection risks, a lack of individualization due to the manualized nature of most IMIs, and the high time and financial costs for both psychotherapists and patients. They expressed a desire for easily accessible information on evidence and programs to reduce the time and effort required for training and advocated for this information to be integrated into the conceptualization of new IMIs. Conclusions: The findings of this study emphasize the importance of considering psychotherapists? attitudes in the development, evaluation, and implementation of IMIs. This study revealed that psychotherapists recognized both the opportunities and risks associated with the use of IMIs, with most agreeing that IMIs serve as a tool to support traditional psychotherapy rather than as a substitute for it. Furthermore, it is essential to involve psychotherapists in discussions about IMIs specifically, as well as in the development of new methodologies in psychotherapy more broadly. Overall, this study can advance the use of IMIs in mental health care and contribute to the ongoing societal debate surrounding these interventions. UR - https://formative.jmir.org/2024/1/e51832 UR - http://dx.doi.org/10.2196/51832 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51832 ER - TY - JOUR AU - Cross, Shane AU - Bell, Imogen AU - Nicholas, Jennifer AU - Valentine, Lee AU - Mangelsdorf, Shaminka AU - Baker, Simon AU - Titov, Nick AU - Alvarez-Jimenez, Mario PY - 2024/10/11 TI - Use of AI in Mental Health Care: Community and Mental Health Professionals Survey JO - JMIR Ment Health SP - e60589 VL - 11 KW - mental health KW - health care KW - AI KW - community members KW - mental health professional KW - web-based survey KW - Australia KW - descriptive statistic KW - thematic analysis KW - cost reduction KW - data security KW - digital health KW - digital intervention KW - artificial intelligence N2 - Background: Artificial intelligence (AI) has been increasingly recognized as a potential solution to address mental health service challenges by automating tasks and providing new forms of support. Objective: This study is the first in a series which aims to estimate the current rates of AI technology use as well as perceived benefits, harms, and risks experienced by community members (CMs) and mental health professionals (MHPs). Methods: This study involved 2 web-based surveys conducted in Australia. The surveys collected data on demographics, technology comfort, attitudes toward AI, specific AI use cases, and experiences of benefits and harms from AI use. Descriptive statistics were calculated, and thematic analysis of open-ended responses were conducted. Results: The final sample consisted of 107 CMs and 86 MHPs. General attitudes toward AI varied, with CMs reporting neutral and MHPs reporting more positive attitudes. Regarding AI usage, 28% (30/108) of CMs used AI, primarily for quick support (18/30, 60%) and as a personal therapist (14/30, 47%). Among MHPs, 43% (37/86) used AI; mostly for research (24/37, 65%) and report writing (20/37, 54%). While the majority found AI to be generally beneficial (23/30, 77% of CMs and 34/37, 92% of MHPs), specific harms and concerns were experienced by 47% (14/30) of CMs and 51% (19/37) of MHPs. There was an equal mix of positive and negative sentiment toward the future of AI in mental health care in open feedback. Conclusions: Commercial AI tools are increasingly being used by CMs and MHPs. Respondents believe AI will offer future advantages for mental health care in terms of accessibility, cost reduction, personalization, and work efficiency. However, they were equally concerned about reducing human connection, ethics, privacy and regulation, medical errors, potential for misuse, and data security. Despite the immense potential, integration into mental health systems must be approached with caution, addressing legal and ethical concerns while developing safeguards to mitigate potential harms. Future surveys are planned to track use and acceptability of AI and associated issues over time. UR - https://mental.jmir.org/2024/1/e60589 UR - http://dx.doi.org/10.2196/60589 ID - info:doi/10.2196/60589 ER - TY - JOUR AU - Kang, Boyoung AU - Hong, Munpyo PY - 2024/9/12 TI - Digital Interventions for Reducing Loneliness and Depression in Korean College Students: Mixed Methods Evaluation JO - JMIR Form Res SP - e58791 VL - 8 KW - loneliness KW - depression KW - digital interventions KW - college students KW - mental health KW - mixed methods evaluation KW - Woebot KW - Happify N2 - Background: The COVID-19 pandemic has exacerbated the prevalence of loneliness and depression among college students. Digital interventions, such as Woebot (Woebot Health, Inc) and Happify (Twill Inc), have shown promise in alleviating these symptoms. Objective: This study aims to investigate the effectiveness and acceptability of Woebot and Happify in reducing loneliness and depression among college students after the COVID-19 pandemic. Methods: A mixed methods approach was used over 4 months. A total of 63 participants aged 18 to 27 years from Sungkyunkwan University in Seoul, South Korea, were initially recruited, with an inclusion criterion of University of California, Los Angeles (UCLA) Loneliness Scale score ?34. The final sample consisted of 27 participants due to attrition. Participants were randomly assigned to Woebot (15/27, 55%); Happify (9/27, 33%); or a control group using Bondee (Metadream), a metaverse social network messenger app (3/27, 11%). Quantitative measures (UCLA Loneliness Scale and Patient Health Questionnaire-9) and qualitative assessments (user feedback and focused interviews) were used. Results: Although mean decreases in loneliness and depression were observed in the control and intervention groups after the intervention, the differences between the control and intervention groups were not statistically significant (UCLA Loneliness: P=.67; Patient Health Questionnaire-9: P=.35). Qualitative data indicated user satisfaction, with suggestions for improved app effectiveness and personalization. Conclusions: Despite limitations, this study highlights the potential of well-designed digital interventions in alleviating college students? loneliness and depression. The findings contribute to the growing body of research on accessible digital mental health tools and underscore the importance of comprehensive support systems. Further research with larger and more diverse samples is needed to better understand the effectiveness and optimization of such interventions. Trial Registration: Clinical Research Information Service KCT0009449; https://bit.ly/4d2e4Bu UR - https://formative.jmir.org/2024/1/e58791 UR - http://dx.doi.org/10.2196/58791 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58791 ER - TY - JOUR AU - Shaker, Abbas Ali AU - Simonsen, Erik AU - Tarp, Kristine AU - Borisov, Aleksandrov Radoslav AU - Sřrensen, Aasted John AU - Bechmann, Henrik AU - Austin, F. Stephen PY - 2024/8/21 TI - Capturing Patients? and Clinicians? Experiences of Using Video Consultations in Mental Health Outpatient Services: Qualitative Thematic Analysis JO - JMIR Form Res SP - e50580 VL - 8 KW - telemedicine KW - telepsychiatry KW - video consultation KW - mobile health KW - mHealth KW - COVID-19 KW - synchronous technology N2 - Background: Over the last decade, there has been an increase in the evidence base supporting the efficacy of video consultations (VCs) in mental health services. Furthermore, the potential of VC treatment was also demonstrated during the COVID-19 pandemic. Despite these promising results and conducive conditions for VCs, several studies have highlighted that the uptake and implementation of VCs continues to be slow, even after the pandemic. To facilitate and strengthen the implementation of VCs and exploit their potential as a useful tool for mental health disorder treatment, there is a need for a deeper understanding of the issues and experiences of implementing and using VCs as a treatment modality in clinical practice. Objective: The aim of this study was to investigate patients? and clinicians? experiences and attitudes toward using VCs in clinical practice. Methods: Treatment was conducted through the VC modality. Semistructured interviews were conducted individually with patients (n=10) and focus group interview were conducted with clinicians (n=4). Patients had participated in weekly VC treatment over 2 months as part of mental health outpatient services in Denmark. Data from these interviews were analyzed using thematic analysis. Results: Thematic analysis of the patient interviews yielded two main themes: (1) adjusting to the practicalities of the VC format and (2) the practice of therapy using VCs. Patients experienced that using VCs was easy and convenient, and it was possible to establish and maintain a therapeutic alliance. They also described the contact as different to in-person therapy. The thematic analysis conducted on clinicians? experiences of using VCs yielded three themes: (1) a shift in mindset from resistance to acceptance, (2) the contact is different when using the VC modality, and (3) adapting to a new way of working. Clinicians experienced that their initial concerns and resistance toward VC implementation gradually diminished over time as they gained clinical experience of using the modality. They expressed that contact with patients can be different when using the VC modality and that it took time to adjust to a new way of working therapeutically. Conclusions: Both patients and clinicians experienced that VCs could enhance access to treatment and be meaningfully integrated into clinical practice. In addition, both groups described the contact when using the VC modality as being different to in-person therapy. Future research could examine patients? and clinicians? perceived differences regarding contact when using the VC modality and the implications for therapeutic interventions. UR - https://formative.jmir.org/2024/1/e50580 UR - http://dx.doi.org/10.2196/50580 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50580 ER - TY - JOUR AU - Zhang, Melody AU - Scandiffio, Jillian AU - Younus, Sarah AU - Jeyakumar, Tharshini AU - Karsan, Inaara AU - Charow, Rebecca AU - Salhia, Mohammad AU - Wiljer, David PY - 2023/12/7 TI - The Adoption of AI in Mental Health Care?Perspectives From Mental Health Professionals: Qualitative Descriptive Study JO - JMIR Form Res SP - e47847 VL - 7 KW - artificial intelligence KW - education KW - mental health KW - behavioral health KW - educators KW - curriculum N2 - Background: Artificial intelligence (AI) is transforming the mental health care environment. AI tools are increasingly accessed by clients and service users. Mental health professionals must be prepared not only to use AI but also to have conversations about it when delivering care. Despite the potential for AI to enable more efficient and reliable and higher-quality care delivery, there is a persistent gap among mental health professionals in the adoption of AI. Objective: A needs assessment was conducted among mental health professionals to (1) understand the learning needs of the workforce and their attitudes toward AI and (2) inform the development of AI education curricula and knowledge translation products. Methods: A qualitative descriptive approach was taken to explore the needs of mental health professionals regarding their adoption of AI through semistructured interviews. To reach maximum variation sampling, mental health professionals (eg, psychiatrists, mental health nurses, educators, scientists, and social workers) in various settings across Ontario (eg, urban and rural, public and private sector, and clinical and research) were recruited. Results: A total of 20 individuals were recruited. Participants included practitioners (9/20, 45% social workers and 1/20, 5% mental health nurses), educator scientists (5/20, 25% with dual roles as professors/lecturers and researchers), and practitioner scientists (3/20, 15% with dual roles as researchers and psychiatrists and 2/20, 10% with dual roles as researchers and mental health nurses). Four major themes emerged: (1) fostering practice change and building self-efficacy to integrate AI into patient care; (2) promoting system-level change to accelerate the adoption of AI in mental health; (3) addressing the importance of organizational readiness as a catalyst for AI adoption; and (4) ensuring that mental health professionals have the education, knowledge, and skills to harness AI in optimizing patient care. Conclusions: AI technologies are starting to emerge in mental health care. Although many digital tools, web-based services, and mobile apps are designed using AI algorithms, mental health professionals have generally been slower in the adoption of AI. As indicated by this study?s findings, the implications are 3-fold. At the individual level, digital professionals must see the value in digitally compassionate tools that retain a humanistic approach to care. For mental health professionals, resistance toward AI adoption must be acknowledged through educational initiatives to raise awareness about the relevance, practicality, and benefits of AI. At the organizational level, digital professionals and leaders must collaborate on governance and funding structures to promote employee buy-in. At the societal level, digital and mental health professionals should collaborate in the creation of formal AI training programs specific to mental health to address knowledge gaps. This study promotes the design of relevant and sustainable education programs to support the adoption of AI within the mental health care sphere. UR - https://formative.jmir.org/2023/1/e47847 UR - http://dx.doi.org/10.2196/47847 UR - http://www.ncbi.nlm.nih.gov/pubmed/38060307 ID - info:doi/10.2196/47847 ER - TY - JOUR AU - Wilczewski, Hattie AU - Paige, R. Samantha AU - Ong, Triton AU - Soni, Hiral AU - Barrera, F. Janelle AU - Welch, M. Brandon AU - Bunnell, E. Brian PY - 2022/11/11 TI - Providers? Perspectives on Telemental Health Usage After the COVID-19 Pandemic: Retrospective Analysis JO - JMIR Form Res SP - e39634 VL - 6 IS - 11 KW - telemedicine KW - telehealth KW - COVID-19 KW - telemental health KW - mental health KW - pandemic KW - perception KW - use KW - usefulness KW - usage KW - workflow N2 - Background: Mental health care pivoted to telemedicine during the COVID-19 pandemic, and there is uncertainty around the sustainability of this rapid shift. Objective: This study examined how intentions to continue using telemedicine after the COVID-19 pandemic are influenced by provider perceptions of usefulness, ease of use, and professional social influence, facilitating organizational conditions. Methods: We conducted a web-based, cross-sectional survey of 369 telemental health providers between February and March 2021. A hierarchical linear regression analysis was conducted to predict intentions to continue using telemedicine after the COVID-19 pandemic. Results: Most providers began using telemedicine in March 2020 or later (257/369, 69.6%) and attended to ?50% of their clients via telemedicine (299/369, 81.0%). Intention to continue using telemedicine after the COVID-19 pandemic was predicted by the telemedicine caseload (?=.10; P=.005), perceived usefulness in general (?=.10; P=.008), ease of use (?=.08; P=.04), social influence (?=.68; P<.001), and facilitating conditions (?=.08; P=.047). Conclusions: Exploration of the predictors of telemedicine usage beyond the COVID-19 pandemic aids in surveillance of telemedicine usage, integration with future clinic workflows, and the shaping of public policy. It is important to consider telemedicine services as not only a response to a crisis but also an effective and useful solution for everyday life. Our results suggest widespread, sustainable telemedicine adoption. UR - https://formative.jmir.org/2022/11/e39634 UR - http://dx.doi.org/10.2196/39634 UR - http://www.ncbi.nlm.nih.gov/pubmed/36322787 ID - info:doi/10.2196/39634 ER - TY - JOUR AU - van Gils, M. Aniek AU - Visser, NC Leonie AU - Hendriksen, MA Heleen AU - Georges, Jean AU - Muller, Majon AU - Bouwman, H. Femke AU - van der Flier, M. Wiesje AU - Rhodius-Meester, FM Hanneke PY - 2021/12/3 TI - Assessing the Views of Professionals, Patients, and Care Partners Concerning the Use of Computer Tools in Memory Clinics: International Survey Study JO - JMIR Form Res SP - e31053 VL - 5 IS - 12 KW - artificial intelligence KW - clinical decision support systems KW - dementia KW - diagnostic testing KW - diagnosis KW - prognosis KW - communication N2 - Background: Computer tools based on artificial intelligence could aid clinicians in memory clinics in several ways, such as by supporting diagnostic decision-making, web-based cognitive testing, and the communication of diagnosis and prognosis. Objective: This study aims to identify the preferences as well as the main barriers and facilitators related to using computer tools in memory clinics for all end users, that is, clinicians, patients, and care partners. Methods: Between July and October 2020, we sent out invitations to a web-based survey to clinicians using the European Alzheimer?s Disease Centers network and the Dutch Memory Clinic network, and 109 clinicians participated (mean age 45 years, SD 10; 53/109, 48.6% female). A second survey was created for patients and care partners. They were invited via Alzheimer Europe, Alzheimer?s Society United Kingdom, Amsterdam Dementia Cohort, and Amsterdam Aging Cohort. A total of 50 patients with subjective cognitive decline, mild cognitive impairment, or dementia (mean age 73 years, SD 8; 17/34, 34% female) and 46 care partners (mean age 65 years, SD 12; 25/54, 54% female) participated in this survey. Results: Most clinicians reported a willingness to use diagnostic (88/109, 80.7%) and prognostic (83/109, 76.1%) computer tools. User-friendliness (71/109, 65.1%); Likert scale mean 4.5, SD 0.7), and increasing diagnostic accuracy (76/109, 69.7%; mean 4.3, SD 0.7) were reported as the main factors stimulating the adoption of a tool. Tools should also save time and provide clear information on reliability and validity. Inadequate integration with electronic patient records (46/109, 42.2%; mean 3.8, SD 1.0) and fear of losing important clinical information (48/109, 44%; mean 3.7, SD 1.2) were most frequently indicated as barriers. Patients and care partners were equally positive about the use of computer tools by clinicians, both for diagnosis (69/96, 72%) and prognosis (73/96, 76%). In addition, most of them thought favorably regarding the possibility of using the tools themselves. Conclusions: This study showed that computer tools in memory clinics are positively valued by most end users. For further development and implementation, it is essential to overcome the technical and practical barriers of a tool while paying utmost attention to its reliability and validity. UR - https://formative.jmir.org/2021/12/e31053 UR - http://dx.doi.org/10.2196/31053 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870612 ID - info:doi/10.2196/31053 ER - TY - JOUR AU - Doukani, Asmae AU - Cerga Pashoja, Arlinda AU - Fanaj, Naim AU - Qirjako, Gentiana AU - Meksi, Andia AU - Mustafa, Sevim AU - Vis, Christiaan AU - Hug, Juliane PY - 2021/11/1 TI - Organizational Readiness for Implementing an Internet-Based Cognitive Behavioral Therapy Intervention for Depression Across Community Mental Health Services in Albania and Kosovo: Directed Qualitative Content Analysis JO - JMIR Form Res SP - e29280 VL - 5 IS - 11 KW - e-mental health KW - digital mental health KW - internet-based cognitive behavioral therapy KW - implementation science KW - organizational readiness for implementing change KW - community mental health center KW - qualitative interviews KW - content analysis KW - Albania and Kosovo N2 - Background: The use of digital mental health programs such as internet-based cognitive behavioral therapy (iCBT) holds promise in increasing the quality and access of mental health services. However very little research has been conducted in understanding the feasibility of implementing iCBT in Eastern Europe. Objective: The aim of this study was to qualitatively assess organizational readiness for implementing iCBT for depression within community mental health centers (CMHCs) across Albania and Kosovo. Methods: We used qualitative semistructured focus group discussions that were guided by Bryan Weiner?s model of organizational readiness for implementing change. The questions broadly explored shared determination to implement change (change commitment) and shared belief in their collective capability to do so (change efficacy). Data were collected between November and December 2017. A range of health care professionals working in and in association with CMHCs were recruited from 3 CMHCs in Albania and 4 CMHCs in Kosovo, which were participating in a large multinational trial on the implementation of iCBT across 9 countries (Horizon 2020 ImpleMentAll project). Data were analyzed using a directed approach to qualitative content analysis, which used a combination of both inductive and deductive approaches. Results: Six focus group discussions involving 69 mental health care professionals were conducted. Participants from Kosovo (36/69, 52%) and Albania (33/69, 48%) were mostly females (48/69, 70%) and nurses (26/69, 38%), with an average age of 41.3 years. A directed qualitative content analysis revealed several barriers and facilitators potentially affecting the implementation of digital CBT interventions for depression in community mental health settings. While commitment for change was high, change efficacy was limited owing to a range of situational factors. Barriers impacting ?change efficacy? included lack of clinical fit for iCBT, high stigma affecting help-seeking behaviors, lack of human resources, poor technological infrastructure, and high caseload. Facilitators included having a high interest and capability in receiving training for iCBT. For ?change commitment,? participants largely expressed welcoming innovation and that iCBT could increase access to treatments for geographically isolated people and reduce the stigma associated with mental health care. Conclusions: In summary, participants perceived iCBT positively in relation to promoting innovation in mental health care, increasing access to services, and reducing stigma. However, a range of barriers was also highlighted in relation to accessing the target treatment population, a culture of mental health stigma, underdeveloped information and communications technology infrastructure, and limited appropriately trained health care workforce, which reduce organizational readiness for implementing iCBT for depression. Such barriers may be addressed through (1) a public-facing campaign that addresses mental health stigma, (2) service-level adjustments that permit staff with the time, resources, and clinical supervision to deliver iCBT, and (3) establishment of a suitable clinical training curriculum for health care professionals. Trial Registration: ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883 UR - https://formative.jmir.org/2021/11/e29280 UR - http://dx.doi.org/10.2196/29280 UR - http://www.ncbi.nlm.nih.gov/pubmed/34723822 ID - info:doi/10.2196/29280 ER - TY - JOUR AU - Mouchabac, Stephane AU - Leray, Philippe AU - Adrien, Vladimir AU - Gollier-Briant, Fanny AU - Bonnot, Olivier PY - 2021/9/30 TI - Prevention of Suicidal Relapses in Adolescents With a Smartphone Application: Bayesian Network Analysis of a Preclinical Trial Using In Silico Patient Simulations JO - J Med Internet Res SP - e24560 VL - 23 IS - 9 KW - suicide KW - bayesian network KW - smartphone application KW - digital psychiatry KW - artificial intelligence N2 - Background: Recently, artificial intelligence technologies and machine learning methods have offered attractive prospects to design and manage crisis response processes, especially in suicide crisis management. In other domains, most algorithms are based on big data to help diagnose and suggest rational treatment options in medicine. But data in psychiatry are related to behavior and clinical evaluation. They are more heterogeneous, less objective, and incomplete compared to other fields of medicine. Consequently, the use of psychiatric clinical data may lead to less accurate and sometimes impossible-to-build algorithms and provide inefficient digital tools. In this case, the Bayesian network (BN) might be helpful and accurate when constructed from expert knowledge. Medical Companion is a government-funded smartphone application based on repeated questions posed to the subject and algorithm-matched advice to prevent relapse of suicide attempts within several months. Objective: Our paper aims to present our development of a BN algorithm as a medical device in accordance with the American Psychiatric Association digital healthcare guidelines and to provide results from a preclinical phase. Methods: The experts are psychiatrists working in university hospitals who are experienced and trained in managing suicidal crises. As recommended when building a BN, we divided the process into 2 tasks. Task 1 is structure determination, representing the qualitative part of the BN. The factors were chosen for their known and demonstrated link with suicidal risk in the literature (clinical, behavioral, and psychometrics) and therapeutic accuracy (advice). Task 2 is parameter elicitation, with the conditional probabilities corresponding to the quantitative part. The 4-step simulation (use case) process allowed us to ensure that the advice was adapted to the clinical states of patients and the context. Results: For task 1, in this formative part, we defined clinical questions related to the mental state of the patients, and we proposed specific factors related to the questions. Subsequently, we suggested specific advice related to the patient?s state. We obtained a structure for the BN with a graphical representation of causal relations between variables. For task 2, several runs of simulations confirmed the a priori model of experts regarding mental state, refining the precision of our model. Moreover, we noticed that the advice had the same distribution as the previous state and was clinically relevant. After 2 rounds of simulation, the experts found the exact match. Conclusions: BN is an efficient methodology to build an algorithm for a digital assistant dedicated to suicidal crisis management. Digital psychiatry is an emerging field, but it needs validation and testing before being used with patients. Similar to psychotropics, any medical device requires a phase II (preclinical) trial. With this method, we propose another step to respond to the American Psychiatric Association guidelines. Trial Registration: ClinicalTrials.gov NCT03975881; https://clinicaltrials.gov/ct2/show/NCT03975881 UR - https://www.jmir.org/2021/9/e24560 UR - http://dx.doi.org/10.2196/24560 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591030 ID - info:doi/10.2196/24560 ER - TY - JOUR AU - Silfee, Valerie AU - Williams, Kelly AU - Leber, Brett AU - Kogan, Jane AU - Nikolajski, Cara AU - Szigethy, Eva AU - Serio, Catherine PY - 2021/9/28 TI - Health Care Provider Perspectives on the Use of a Digital Behavioral Health App to Support Patients: Qualitative Study JO - JMIR Form Res SP - e28538 VL - 5 IS - 9 KW - digital health KW - mHealth KW - implementation KW - cognitive behavioral therapy KW - anxiety KW - depression KW - smartphone KW - mobile phone N2 - Background: Despite the growing evidence indicating the efficacy of digital cognitive behavioral interventions (dCBIs) for behavioral health (BH) treatment, broad and consistent use of such interventions has been limited by knowledge obtained in real-world settings, including factors that impact provider uptake/referral. Engaging providers early in the implementation process offers an opportunity to explore their needs and behaviors, integrate interventions into workflows, and better understand provider setting capabilities. Objective: This study assessed providers? views on the feasibility and acceptability of delivering a cognitive behavioral therapy (CBT)-based mobile app in multiple care settings. Methods: Participating providers included BH and physical health (PH) providers from a women?s health center, an outpatient BH clinic, and both rural/urban primary care settings. All participating providers cocreated workflows through facilitated workshops, including establishing feedback loops between the project team and providers and identifying clinical champions at each site. Over a 12-week period, the providers referred adult patients experiencing anxiety or depression to a mobile app-based dCBI, RxWell, and provided other indicated treatments as part of usual care. Referrals were completed by the providers through the electronic medical record. To better understand facilitators of and challenges in integrating RxWell into routine practice and perceptions of sustainability, a series of qualitative interviews was conducted. Interview data were analyzed to identify major themes using an inductive content analysis approach. Results: A total of 19 provider interviews were conducted to discover motivators and barriers for referring RxWell. The providers benefited from a focused discussion on how to incorporate the referral process into their workflow, and knowing the app content was rooted in evidence. Although the providers believed engaging in experiential learning was important, they indicated that more education on the digital health coach role and how to monitor patient progress is needed. The providers thought patient engagement may be impacted by motivation, a lack of comfort using a smartphone, or preference for in-person therapy. The providers also expressed enthusiasm in continuing to refer the app. They liked the ability to provide patients with support between sessions, to have an extra treatment option that teaches BH exercises, and to have a CBT treatment option that overcomes barriers (eg, wait times, copays, travel) to traditional therapy modalities. Conclusions: Digital intervention success in health care settings relies heavily on engagement of key stakeholders, such as providers, in both design and implementation of the intervention and focused evaluation within intended care setting(s). Scaling digital interventions to meet the mental health needs of patients in usual care settings leans on thoughtfully constructed and streamlined workflows to enable seamless referral of patients by providers. Our findings strongly suggest that providers are supportive of digital tool integration to support the mental health of patients and endorse its use within their routine workflow. UR - https://formative.jmir.org/2021/9/e28538 UR - http://dx.doi.org/10.2196/28538 UR - http://www.ncbi.nlm.nih.gov/pubmed/34529583 ID - info:doi/10.2196/28538 ER - TY - JOUR AU - Budhwani, Suman AU - Fujioka, Keiko Jamie AU - Chu, Cherry AU - Baranek, Hayley AU - Pus, Laura AU - Wasserman, Lori AU - Vigod, Simone AU - Martin, Danielle AU - Agarwal, Payal AU - Mukerji, Geetha PY - 2021/9/21 TI - Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context JO - JMIR Form Res SP - e30280 VL - 5 IS - 9 KW - virtual care KW - mental health KW - quality of care KW - implementation KW - COVID-19 KW - digital health KW - pandemic KW - ambulatory care N2 - Background: Virtual care delivery within mental health has increased rapidly during the COVID-19 pandemic. Understanding facilitators and challenges to adoption and perceptions of the quality of virtual care when delivered at scale can inform service planning postpandemic. Objective: We sought to understand consistent facilitators and persistent challenges to adoption of virtual care and perceived impact on quality of care in an initial pilot phase prior to the pandemic and then during scaled use during the pandemic in the mental health department of an ambulatory care hospital. Methods: This study took place at Women?s College Hospital, an academic ambulatory hospital located in Toronto, Canada. We utilized a multimethods approach to collect quantitative data through aggregate utilization data of phone, video, and in-person visits prior to and during COVID-19 lockdown measures and through a provider experience survey administered to mental health providers (n=30). Qualitative data were collected through open-ended questions on provider experience surveys, focus groups (n=4) with mental health providers, and interviews with clinical administrative and implementation hospital staff (n=3). Results: Utilization data demonstrated slower uptake of video visits at launch and prior to COVID-19 lockdown measures in Ontario (pre-March 2020) and subsequent increased uptake of phone and video visits during COVID-19 lockdown measures (post-March 2020). Mental health providers and clinic staff highlighted barriers and facilitators to adoption of virtual care at the operational, behavioral, cultural, and system/policy levels such as required changes in workflows and scheduling, increased provider effort, provider and staff acceptance, and billing codes for physician providers. Much of the described provider experiences focused on perceived impact on quality of mental health care delivery, including perceptions on providing appropriate and patient-centered care, virtual care effectiveness, and equitable access to care for patients. Conclusions: Continued efforts to enhance suggested facilitators, reduce persistent challenges, and address provider concerns about care quality based on these findings can enable a hybrid model of patient-centered and appropriate care to emerge in the future, with options for in-person, video, and phone visits being used to meet patient and clinical needs as required. UR - https://formative.jmir.org/2021/9/e30280 UR - http://dx.doi.org/10.2196/30280 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406967 ID - info:doi/10.2196/30280 ER - TY - JOUR AU - Feijt, A. Milou AU - de Kort, W. Yvonne A. AU - Westerink, M. Joyce H. D. AU - Bierbooms, A. Joyce J. P. AU - Bongers, B. Inge M. AU - IJsselsteijn, A. Wijnand PY - 2021/9/17 TI - Assessing Professionals? Adoption Readiness for eMental Health: Development and Validation of the eMental Health Adoption Readiness Scale JO - J Med Internet Res SP - e28518 VL - 23 IS - 9 KW - eMental health KW - adoption of innovation KW - mental health care KW - scale development N2 - Background: The last few decades have witnessed significant advances in the development of digital tools and applications for mental health care. Despite growing evidence for their effectiveness, acceptance and use of these tools in clinical practice remain low. Hence, a validated and easy-to-use instrument for assessing professionals? readiness to adopt eMental health (EMH) is necessary to gain further insights into the process of EMH adoption and facilitate future research on this topic. Objective: The aim of this study is to develop and validate an instrument for assessing mental health care professionals? readiness to adopt EMH. Methods: Item generation was guided by literature and inputs from mental health care professionals and experts in survey development. Exploratory factor analyses were conducted on an initial set of 29 items completed by a sample of mental health care professionals (N=432); thereafter, the scale was reduced to 15 items in an iterative process. The factor structure thus obtained was subsequently tested using a confirmatory factor analysis with a second sample of mental health care professionals (N=363). The internal consistency, convergent validity, and predictive validity of the eMental Health Adoption Readiness (eMHAR) Scale were assessed. Results: Exploratory factor analysis resulted in a 3-factor solution with 15 items. The factors were analyzed and labeled as perceived benefits and applicability of EMH, EMH proactive innovation, and EMH self-efficacy. These factors were confirmed through a confirmatory factor analysis. The total scale and subscales showed a good internal consistency (Cronbach ?=.73-.88) along with acceptable convergent and predictive relationships with related constructs. Conclusions: The constructed eMHAR Scale showed a conceptually interpretable 3-factor structure having satisfactory characteristics and relationships with relevant concepts. Its ease of use allows for quick acquisition of data that can contribute to understanding and facilitating the process of adoption of EMH by clinical professionals. UR - https://www.jmir.org/2021/9/e28518 UR - http://dx.doi.org/10.2196/28518 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533469 ID - info:doi/10.2196/28518 ER - TY - JOUR AU - Smith-MacDonald, Lorraine AU - Jones, Chelsea AU - Sevigny, Phillip AU - White, Allison AU - Laidlaw, Alexa AU - Voth, Melissa AU - Mikolas, Cynthia AU - Heber, Alexandra AU - Greenshaw, J. Andrew AU - Brémault-Phillips, Suzette PY - 2021/8/12 TI - The Experience of Key Stakeholders During the Implementation and Use of Trauma Therapy via Digital Health for Military, Veteran, and Public Safety Personnel: Qualitative Thematic Analysis JO - JMIR Form Res SP - e26369 VL - 5 IS - 8 KW - trauma KW - mental health KW - telemedicine KW - therapy KW - rehabilitation KW - digital health KW - psychotherapy KW - military KW - veteran KW - first responder KW - public safety personnel KW - teletherapy KW - telepsychiatry KW - mobile phone N2 - Background: Exposure to occupational stressors and potentially psychologically traumatic events experienced by public safety personnel (eg, paramedics, police, fire, and correctional officers), military members, and veterans can lead to the development of posttraumatic stress injuries and other mental health disorders. Providing emergency services during COVID-19 has intensified the challenges. Owing to COVID-19 restrictions, mental health service providers offering support to these populations have had to rapidly pivot to use digital versus in-person methods of service delivery. Objective: This paper aims to explore the experience of mental health service providers regarding digital health service delivery, including the current state of digital mental health service delivery, barriers to and facilitators of the use of digital health for mental health service delivery experienced during the pandemic, and recommendations for implementing and integrating digital health into regular mental health service delivery. Methods: This embedded mixed-methods study included questionnaires and focus groups with key stakeholders (N=31) with knowledge and experience in providing mental health services. Data analysis included descriptive, quantitative, and qualitative thematic analyses. Results: The following three themes emerged: being forced into change, daring to deliver mental health services using digital health, and future possibilities offered by digital health. In each theme, participants? responses reflected their perceptions of service providers, organizations, and clients. The findings offer considerations regarding for whom and at what point in treatment digital health delivery is appropriate; recommendations for training, support, resources, and guidelines for digitally delivering trauma therapy; and a better understanding of factors influencing mental health service providers? perceptions and acceptance of digital health for mental health service delivery. Conclusions: The results indicate the implementation of digital health for mental health service delivery to military members, public safety personnel, and veterans. As the COVID-19 pandemic continues, remote service delivery methods for trauma therapy are urgently needed to support the well-being of those who have served and continue to serve. UR - https://formative.jmir.org/2021/8/e26369 UR - http://dx.doi.org/10.2196/26369 UR - http://www.ncbi.nlm.nih.gov/pubmed/34387549 ID - info:doi/10.2196/26369 ER - TY - JOUR AU - de Looff, Christiaan Pieter AU - Nijman, Henk AU - Didden, Robert AU - Noordzij, L. Matthijs PY - 2021/5/10 TI - Usability and Acceptance of Wearable Biosensors in Forensic Psychiatry: Cross-sectional Questionnaire Study JO - JMIR Form Res SP - e18096 VL - 5 IS - 5 KW - forensic psychiatry KW - wearable biosensors KW - intellectual disabilities KW - usability KW - acceptance KW - continuous use KW - emotion regulation KW - behavior regulation N2 - Background: The use of wearable biosensor devices for monitoring and coaching in forensic psychiatric settings yields high expectations for improved self-regulation of emotions and behavior in clients and staff members. More so, if clients have mild intellectual disabilities (IQ 50-85), they might benefit from these biosensors as they are easy to use in everyday life, which ensures that clients can practice with the devices in multiple stress and arousal-inducing situations. However, research on (continuous) use and acceptance of biosensors in forensic psychiatry for clients with mild intellectual disabilities and their caretakers is scarce. Although wearable biosensors show promise for health care, recent research showed that the acceptance and continuous use of wearable devices in consumers is not as was anticipated, probably due to low expectations. Objective: The main goal of this study was to investigate the associations between and determinants of the expectation of usability, the actual experienced usability, and the intention for continuous use of biosensors. Methods: A total of 77 participants (31 forensic clients with mild intellectual disabilities and 46 forensic staff members) participated in a 1-week trial. Preceding the study, we selected 4 devices thought to benefit the participants in domains of self-regulation, physical health, or sleep. Qualitative and quantitative questionnaires were used that explored the determinants of usability, acceptance, and continuous use of biosensors. Questionnaires consisted of the System Usability Scale, the Technology Acceptance Model questionnaire, and the extended expectation confirmation model questionnaire. Results: Only the experienced usability of the devices was associated with intended continuous use. Forensic clients scored higher on acceptance and intention for continuous use than staff members. Moderate associations were found between usability with acceptance and continuous use. Staff members showed stronger associations between usability and acceptance (r=.80, P<.001) and usability and continuous use (r=.79, P<.001) than clients, who showed more moderate correlations between usability and acceptance (r=.46, P=.01) and usability and continuous use (r=.52, P=.003). The qualitative questionnaires in general indicated that the devices were easy to use and gave clear information. Conclusions: Contrary to expectations, it was the actual perceived usability of wearing a biosensor that was associated with continuous use and to a much lesser extent the expectancy of usability. Clients scored higher on acceptance and intention for continuous use, but associations between usability and both acceptance and continuous use were markedly stronger in staff members. This study provides clear directions on how to further investigate these associations. For example, whether this is a true effect or due to a social desirability bias in the client group must be investigated. Clients with mild intellectual disabilities might benefit from the ease of use of these devices and their continuing monitoring and coaching apps. For these clients, it is especially important to develop easy-to-use biosensors with a minimum requirement on cognitive capacity to increase usability, acceptance, and continuous use. UR - https://formative.jmir.org/2021/5/e18096 UR - http://dx.doi.org/10.2196/18096 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970115 ID - info:doi/10.2196/18096 ER - TY - JOUR AU - AlHadi, N. Ahmad AU - Alammari, A. Khawla AU - Alsiwat, J. Lojain AU - Alhaidri, E. Nojood AU - Alabdulkarim, H. Nouf AU - Altwaijri, A. Nouf AU - AlSohaili, A. Shamma PY - 2021/5/3 TI - Perception of Mental Health Care Professionals in Saudi Arabia on Computerized Cognitive Behavioral Therapy: Observational Cross-sectional Study JO - JMIR Form Res SP - e26294 VL - 5 IS - 5 KW - CBT KW - iCBT KW - cCBT KW - knowledge KW - attitude KW - mental health care professionals KW - computer usage KW - psychotherapy KW - therapy KW - cognitive behavioral therapy KW - health care worker KW - perception KW - Saudi Arabia KW - preference KW - mental health N2 - Background: Mental health disorders are common in Saudi Arabia with a 34% lifetime prevalence. Cognitive behavioral therapy (CBT), a type of psychotherapy, is an evidence-based intervention for the majority of mental disorders. Although the demand for CBT is increasing, unfortunately, there are few therapists available to meet this demand and the therapy is expensive. Computerized cognitive behavioral therapy (cCBT) is a new modality that can help fill this gap. Objective: We aimed to measure the knowledge of cCBT among mental health care professionals in Saudi Arabia, and to evaluate their attitudes and preferences toward cCBT. Methods: This quantitative observational cross-sectional study used a convenience sample, selecting mental health care professionals working in the tertiary hospitals of Saudi Arabia. The participants received a self-administered electronic questionnaire through data collectors measuring their demographics, knowledge, and attitudes about cCBT, and their beliefs about the efficacy of using computers in therapy. Results: Among the 121 participating mental health care professionals, the mean age was 36.55 years and 60.3% were women. Most of the participants expressed uncertainty and demonstrated a lack of knowledge regarding cCBT. However, the majority of participants indicated a positive attitude toward using computers in therapy. Participants agreed with the principles of cCBT, believed in its efficacy, and were generally confident in using computers. Among the notable results, participants having a clinical license and with cCBT experience had more knowledge of cCBT. The overall attitude toward cCBT was not affected by demographic or work-related factors. Conclusions: Mental health care professionals in Saudi Arabia need more education and training regarding cCBT; however, their attitude toward its use and their comfort in using computers in general show great promise. Further research is needed to assess the acceptance of cCBT by patients in Saudi Arabia, in addition to clinical trials measuring its effectiveness in the Saudi population. UR - https://formative.jmir.org/2021/5/e26294 UR - http://dx.doi.org/10.2196/26294 UR - http://www.ncbi.nlm.nih.gov/pubmed/33938810 ID - info:doi/10.2196/26294 ER - TY - JOUR AU - Strudwick, Gillian AU - McLay, David AU - Lo, Brian AU - Shin, Danielle Hwayeon AU - Currie, Leanne AU - Thomson, Nicole AU - Maillet, Éric AU - Strong, Vanessa AU - Miller, Alanna AU - Shen, Nelson AU - Campbell, Janis PY - 2021/4/22 TI - Development of a Resource Guide to Support the Engagement of Mental Health Providers and Patients With Digital Health Tools: Multimethod Study JO - J Med Internet Res SP - e25773 VL - 23 IS - 4 KW - digital health KW - mental health KW - psychiatry KW - COVID-19 KW - nursing informatics KW - health informatics N2 - Background: As mental illness continues to affect 1 in 5 individuals, and the need for support has increased during the COVID-19 pandemic, the promise of digital mental health tools remains largely unrealized due to a lack of uptake by patients and providers. Currently, most efforts on supporting the uptake of digital mental health tools remain fragmented across organizations and geography. There is a critical need to synthesize these efforts in order to provide a coordinated strategy of supporting the adoption of digital mental health tools. Objective: The specific aim of this project is to develop a web-based resource document to support the engagement of mental health providers and patients in the use of digital mental health tools. Methods: The web-based resource was developed using a multimethod approach. A grey literature review was conducted in 2019 to identify relevant toolkits that are available in the public domain. This was supplemented with an environmental scan where individuals with expertise in the development, acquisition, implementation, and evaluation of digital mental health tools were invited to contribute additional tools or documents not identified in the grey literature search. An engagement workshop was held with stakeholders to explore how the resource document should be developed and delivered. These findings were collectively used to develop the final iteration of the resource document. Results: Based on a gray literature review and environmental scan with 27 experts, 25 resources were identified and included in the resource guide. These resources were developed for patients and providers by organizations from 5 countries. An engagement workshop was held with 14 stakeholders, and barriers related to cultural sensitivity, sustainability, and accessibility of the toolkit were identified. The final iteration of the resource document was developed by the research team using findings from the gray literature review, environmental scan, and engagement workshop. The contents of the 45-page resource guide are directed at mental health care providers, administrators, and patients (inclusive of families and caregivers). Conclusions: The use of a multimethod approach led to the development of a resource guide that builds on existing evidence on digital mental health tools and was co-designed with stakeholders and end-users. The resource guide is now publicly available online for free and is being promoted through digital health and mental health websites. Future work should explore how this document can be integrated into clinical care delivery and pathways. UR - https://www.jmir.org/2021/4/e25773 UR - http://dx.doi.org/10.2196/25773 UR - http://www.ncbi.nlm.nih.gov/pubmed/33885374 ID - info:doi/10.2196/25773 ER - TY - JOUR AU - Armstrong, C. Courtney AU - Odukoya, J. Erica AU - Sundaramurthy, Keerthi AU - Darrow, M. Sabrina PY - 2021/4/22 TI - Youth and Provider Perspectives on Behavior-Tracking Mobile Apps: Qualitative Analysis JO - JMIR Ment Health SP - e24482 VL - 8 IS - 4 KW - qualitative KW - mHealth KW - mobile phone KW - behavior monitoring KW - youth N2 - Background: Mobile health apps stand as one possible means of improving evidence-based mental health interventions for youth. However, a better understanding of youth and provider perspectives is necessary to support widespread implementation. Objective: The objective of this research was to explore both youth and provider perspectives on using mobile apps to enhance evidence-based clinical care, with an emphasis on gathering perspectives on behavior-tracking apps. Methods: Inductive qualitative analysis was conducted on data obtained from semistructured interviews held with 10 youths who received psychotherapy and 12 mental health care providers who conducted therapy with youths aged 13-26 years. Interviews were independently coded by multiple coders and consensus meetings were held to establish reliability. Results: During the interviews, the youths and providers broadly agreed on the benefits of behavior tracking and believed that tracking via app could be more enjoyable and accessible. Providers and youths also shared similar concerns that negative emotions and user burden could limit app usage. Participants also suggested potential app features that, if implemented, would help meet the clinical needs of providers and support long-term use among youth. Such features included having a pleasant user interface, reminders for clients, and graphical output of data to clients and providers. Conclusions: Youths and providers explained that the integration of mobile health into psychotherapy has the potential to make treatment, particularly behavior tracking, easy and more accessible. However, both groups had concerns about the increased burden that could be placed on the clients and providers. UR - https://mental.jmir.org/2021/4/e24482 UR - http://dx.doi.org/10.2196/24482 UR - http://www.ncbi.nlm.nih.gov/pubmed/33885364 ID - info:doi/10.2196/24482 ER - TY - JOUR AU - Jung, Young Se AU - Hwang, Hee AU - Lee, Keehyuck AU - Lee, Donghyun AU - Yoo, Sooyoung AU - Lim, Kahyun AU - Lee, Ho-Young AU - Kim, Eric PY - 2021/4/8 TI - User Perspectives on Barriers and Facilitators to the Implementation of Electronic Health Records in Behavioral Hospitals: Qualitative Study JO - JMIR Form Res SP - e18764 VL - 5 IS - 4 KW - electronic health records KW - mental health care KW - qualitative study KW - mobile phone N2 - Background: Despite the rapid adoption of electronic health records (EHRs) resulting from the reimbursement program of the US government, EHR adoption in behavioral hospitals is still slow, and there remains a lack of evidence regarding barriers and facilitators to the implementation of mental health care EHRs. Objective: The aim of this study is to analyze the experience of mental health professionals to explore the perceived barriers, facilitators, and critical ideas influencing the implementation and usability of a mental health care EHR. Methods: In this phenomenological qualitative study, we interviewed physicians, nurses, pharmacists, mental health clinicians, and administrative professionals separately at 4 behavioral hospitals in the United States. We conducted semistructured interviews (N=43) from behavioral hospitals involved in the adoption of the mental health care EHR. Purposeful sampling was used to maximize the diversity. Transcripts were coded and analyzed for emergent domains. An exploratory data analysis was conducted. Results: Content analyses revealed 7 barriers and 4 facilitators. The most important barriers to implementing the mental health care EHR were the low levels of computer proficiency among nurses, complexity of the system, alert fatigue, and resistance because of legacy systems. This led to poor usability, low acceptability, and distrust toward the system. The major facilitators to implementing the mental health care EHR were well-executed training programs, improved productivity, better quality of care, and the good usability of the mental health care EHR. Conclusions: Health care professionals expected to enhance their work productivity and interprofessional collaboration by introducing the mental health care EHR. Routine education for end users is an essential starting point for the successful implementation of mental health care EHR electronic decision support. When adopting the mental health care EHR, managers need to focus on common practices in behavioral hospitals, such as documenting structured data in their organizations and adopting a seamless workflow of mental health care into the system. UR - https://formative.jmir.org/2021/4/e18764 UR - http://dx.doi.org/10.2196/18764 UR - http://www.ncbi.nlm.nih.gov/pubmed/33830061 ID - info:doi/10.2196/18764 ER - TY - JOUR AU - Singla, Radha Daisy AU - Lemberg-Pelly, Sasha AU - Lawson, Andrea AU - Zahedi, Nika AU - Thomas-Jacques, Tyla AU - Dennis, Cindy-Lee PY - 2020/8/27 TI - Implementing Psychological Interventions Through Nonspecialist Providers and Telemedicine in High-Income Countries: Qualitative Study from a Multistakeholder Perspective JO - JMIR Ment Health SP - e19271 VL - 7 IS - 8 KW - nonspecialist providers KW - task sharing KW - perinatal mental health KW - perinatal depression KW - telemedicine KW - psychological treatments N2 - Background: Task sharing has been used worldwide to improve access to mental health care, where nonspecialist providers?individuals with no formal training in mental health?have been trained to effectively treat perinatal depressive and anxiety symptoms. Little formative research has been conducted to examine relevant barriers and facilitators of nonspecialist providers and the use of telemedicine in treatment service delivery. Objective: The primary objective of this study was to examine the main barriers and facilitators of nonspecialist provider?delivered psychological treatments for perinatal populations with common mental health disorders, such as depression and anxiety, from a multistakeholder perspective. Methods: This study took place in Toronto, Canada. In total, 33 in-depth interviews were conducted with multiple stakeholder groups (women with lived experience and their significant others, as well as health and mental health professionals). Qualitative data were quantified to estimate commonly endorsed themes within and across stakeholder groups. Results: Psychological treatments delivered by nonspecialist providers were considered acceptable by the vast majority of participants (30/33, 90%). Across all stakeholder groups, nurses (20/33, 61%) and midwives (14/33, 42%) were the most commonly endorsed cadre of nonspecialist providers. The majority of stakeholders (32/33, 97%) were amenable to nonspecialist providers delivering psychological treatment via telemedicine (27/33, 82%), although concerns were raised about the ability to establish a therapeutic alliance via telemedicine (16/33, 48%). Empathy was the most desired characteristic of a nonspecialist provider (61%). Patient and patient advocate stakeholders were more likely to emphasize stigma as an important barrier to accessing psychological treatments (7/12, 58%), compared to clinicians (2/9, 22%) and spouses (1/5, 20%). Clinician stakeholders were more likely to emphasize the importance of ensuring nonspecialist providers were trained to deliver psychological treatments (3/9, 33%), compared to other stakeholder groups. Conclusions: These results can inform the design, implementation, and integration of nonspecialist-delivered interventions via telemedicine for women with perinatal depressive and anxiety symptoms in high-income country contexts. UR - http://mental.jmir.org/2020/8/e19271/ UR - http://dx.doi.org/10.2196/19271 UR - http://www.ncbi.nlm.nih.gov/pubmed/32852281 ID - info:doi/10.2196/19271 ER - TY - JOUR AU - Jain, Nikhil AU - Jayaram, Mahesh PY - 2020/8/21 TI - Comment on "Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow" JO - JMIR Ment Health SP - e23023 VL - 7 IS - 8 KW - telepsychiatry KW - COVID-19 KW - Australia UR - https://mental.jmir.org/2020/8/e23023 UR - http://dx.doi.org/10.2196/23023 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750003 ID - info:doi/10.2196/23023 ER - TY - JOUR AU - Friesen, Laura AU - Gaine, Graham AU - Klaver, Ellen AU - Klingle, Kirsten AU - Parmar, Devashree AU - Hrabok, Marianne AU - Kelland, Jill AU - Surood, Shireen AU - Agyapong, Vincent PY - 2020/8/20 TI - Bridging the Gap in Community Care for Patients With Borderline Personality Disorder: Protocol for Qualitative Inquiry Into Patient, Caregiver, and Clinician Perspectives on Service Gaps and Potential Solutions for Severe Emotion Dysregulation JO - JMIR Res Protoc SP - e14885 VL - 9 IS - 8 KW - borderline personality disorder KW - mental health services KW - health care quality KW - access KW - evaluation KW - care pathways N2 - Background: Borderline personality disorder (BPD) is characterized by severe emotion dysregulation that is often complicated by comorbid diagnoses, deliberate self-harm, and chronic suicidal ideation. Unfortunately, current care pathways for individuals with BPD are strained by limited resources, inadequate training, and an overuse of emergency departments and crisis teams. Such barriers result in delayed access to effective treatment, which increases risk of deterioration, disability, and morbidity. A first step toward addressing these limitations of the current care pathway is to understand key stakeholders? lived experiences in this pathway and their perspectives on potential solutions. Objective: The purpose of this paper is to present a protocol for a study that explores the lived experiences of the current care pathway from the perspectives of patients with BPD, as well as their caregivers and clinicians. Methods: A qualitative approach is most appropriate for the exploratory nature of the research objective. Accordingly, 3 to 6 patients with a diagnosis of BPD, 3 caregivers of individuals with BPD, and 3 clinicians of patients diagnosed with BPD will be invited to participate in individual, semistructured interviews that focus on service experiences. Results: It is anticipated that results will yield insight into the lived experiences of patients with BPD, caregivers, and clinicians and provide a better understanding of the perceived gaps in services and potential solutions. Results are expected to be available in 12 months. Conclusions: This paper describes a protocol for a qualitative study that seeks to understand the lived experiences and perspectives of key stakeholders (patients, caregivers, and clinicians) on the current care pathway for BPD. Results will provide a basis for future research in this area and will have the potential to inform training, practice, and policy. International Registered Report Identifier (IRRID): DERR1-10.2196/14885 UR - https://www.researchprotocols.org/2020/8/e14885 UR - http://dx.doi.org/10.2196/14885 UR - http://www.ncbi.nlm.nih.gov/pubmed/32815818 ID - info:doi/10.2196/14885 ER - TY - JOUR AU - Titzler, Ingrid AU - Berking, Matthias AU - Schlicker, Sandra AU - Riper, Heleen AU - Ebert, Daniel David PY - 2020/8/18 TI - Barriers and Facilitators for Referrals of Primary Care Patients to Blended Internet-Based Psychotherapy for Depression: Mixed Methods Study of General Practitioners? Views JO - JMIR Ment Health SP - e18642 VL - 7 IS - 8 KW - barriers and facilitators KW - general practitioners KW - depression KW - referral KW - blended therapy KW - internet-based intervention KW - mobile phone KW - psychotherapy KW - qualitative research N2 - Background: Major depressive disorder (MDD) is highly prevalent and often managed by general practitioners (GPs). GPs mostly prescribe medication and show low referral rates to psychotherapy. Many patients remain untreated. Blended psychotherapy (bPT) combines internet-based interventions with face-to-face psychotherapy and could increase treatment access and availability. Effectively implementing bPT in routine care requires an understanding of professional users? perspectives and behavior. Objective: This study aims to identify barriers and facilitators perceived by GPs in referring patients to bPT. Explanations for variations in referral rates were examined. Methods: Semistructured interviews were conducted with 12 of 110 GPs participating in a German randomized controlled trial (RCT) to investigate barriers to and facilitators for referrals to bPT for MDD (10 web-based modules, app-based assessments, and 6 face-to-face sessions). The interview guide was based on the theoretical domains framework. The interviews were audio recorded and transcribed verbatim, and the qualitative content was analyzed by 2 independent coders (intercoder agreement, k=0.71). A follow-up survey with 12 interviewed GPs enabled the validation of emergent themes. The differences in the barriers and facilitators identified between groups with different characteristics (eg, GPs with high or low referral rates) were described. Correlations between referrals and characteristics, self-rated competences, and experiences managing depression of the RCT-GPs (n=76) were conducted. Results: GPs referred few patients to bPT, although varied in their referral rates, and interviewees referred more than twice as many patients as RCT-GPs (interview-GPs: mean 6.34, SD 9.42; RCT-GPs: mean 2.65, SD 3.92). A negative correlation was found between GPs? referrals and their self-rated pharmacotherapeutic competence, r(73)=?0.31, P<.001. The qualitative findings revealed a total of 19 barriers (B) and 29 facilitators (F), at the levels of GP (B=4 and F=11), patient (B=11 and F=9), GP practice (B=1 and F=3), and sociopolitical circumstances (B=3 and F=6). Key barriers stated by all interviewed GPs included ?little knowledge about internet-based interventions? and ?patients? lack of familiarity with technology/internet/media? (number of statements, each k=22). Key facilitators were ?perceived patient suitability, e.g. well-educated, young? (k=22) and ?no conflict with GP?s role? (k=16). The follow-up survey showed a very high agreement rate of at least 75% for 71% (34/48) of the identified themes. Descriptive findings indicated differences between GPs with low and high referral rates in terms of which and how many barriers (low: mean 9.75, SD 1.83; high: mean 10.50, SD 2.38) and facilitators (low: mean 18.25, SD 4.13; high: mean 21.00; SD 3.92) they mentioned. Conclusions: This study provides insights into factors influencing GPs? referrals to bPT as gatekeepers to depression care. Barriers and facilitators should be considered when designing implementation strategies to enhance referral rates. The findings should be interpreted with care because of the small and self-selected sample and low response rates. UR - http://mental.jmir.org/2020/8/e18642/ UR - http://dx.doi.org/10.2196/18642 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673213 ID - info:doi/10.2196/18642 ER - TY - JOUR AU - Kamel, Mamdouh Mostafa AU - Westenberg, Nicolas Jean AU - Choi, Fiona AU - Tabi, Katarina AU - Badawy, Adel AU - Ramy, Hisham AU - Elsawi, Hossam AU - Krausz, Michael PY - 2020/8/13 TI - Electronic Mental Health as an Option for Egyptian Psychiatry: Cross-Sectional Study JO - JMIR Ment Health SP - e19591 VL - 7 IS - 8 KW - psychiatry KW - e-mental health KW - Arab countries KW - mental health care KW - psychiatrists KW - health care providers N2 - Background: Egypt is a country of nearly 100 million citizens, and there are less than 1000 registered psychiatrists. The mental health care system is under resourced and nearly inaccessible for the majority of the population. In addition, youth under the age of 25 years represent 50% of Egyptian citizens; however, there are no specific services addressing their unique needs. How can the needs of the largest population in the Middle East be effectively addressed? Is a web-based framework an option for Egyptian psychiatrists to serve the population? Objective: The aims of this study were to better understand the opinions of psychiatrists on the current state of mental health care services in Egypt and their current knowledge on electronic mental health (EMH); assess the attitudes of Egyptian psychiatrists toward web-based interventions and telemedicine for mental health; and identify perceived advantages and barriers of EMH development in Egypt. Methods: A cross-sectional survey was conducted online among 640 Egyptian psychiatrists. It included a total of 36 items within a set of 16 questions asking about EMH literacy, integrating EMH into the mental health care system, and the perceived priorities and barriers of EMH. The sampling was supported by Tanta University, a large academic institution close to Cairo. Statistical analysis was performed using SPSS 25 (IBM Corp). Descriptive statistics, the chi-square test, the independent sample t test, and analysis of variance were applied. Results: A total of 188 participants responded (response rate of 29.4%), of which 54.2% (102/188) were female and 54.3% (102/188) were between 30 and 45 years old. Less than half of the participants thought that the current health care system was efficient for adults (69/155, 44.4%), and even less thought it was efficient for youth (44/155, 28.3%). Almost all participants agreed that EMH would be beneficial for patient care (147/155, 94.8%) and that integrating EMH into the current health care system would be a good idea (118/155, 76.2%). The highest rated utility of web-based solutions was documentation, followed by psychoeducation and communication with professionals. The main advantages were to improve access to care in rural areas of the country and its convenience. Conclusions: There is scarcity of mental health resources in Egypt. Egyptian psychiatrists are interested in EMH and believe web-based platforms can become part of the solution for the Egyptian mental health care system. UR - http://mental.jmir.org/2020/8/e19591/ UR - http://dx.doi.org/10.2196/19591 UR - http://www.ncbi.nlm.nih.gov/pubmed/32788155 ID - info:doi/10.2196/19591 ER - TY - JOUR AU - van Dooren, M. Marierose M. AU - Visch, Valentijn AU - Spijkerman, Renske AU - Goossens, M. Richard H. AU - Hendriks, M. Vincent PY - 2020/5/6 TI - Mental Health Therapy Protocols and eHealth Design: Focus Group Study JO - JMIR Form Res SP - e15568 VL - 4 IS - 5 KW - eHealth design KW - mental health care KW - personalization KW - protocol KW - youth addiction care N2 - Background: Electronic health (eHealth) programs are often based on protocols developed for the original face-to-face therapies. However, in practice, therapists and patients may not always follow the original therapy protocols. This form of personalization may also interfere with the intended implementation and effects of eHealth interventions if designers do not take these practices into account. Objective: The aim of this explorative study was to gain insights into the personalization practices of therapists and patients using cognitive behavioral therapy, one of the most commonly applied types of psychotherapy, in a youth addiction care center as a case context. Methods: Focus group discussions were conducted asking therapists and patients to estimate the extent to which a therapy protocol was followed and about the type and reasons for personalization of a given therapy protocol. A total of 7 focus group sessions were organized involving therapists and patients. We used a commonly applied protocol for cognitive behavioral therapy as a therapy protocol example in youth mental health care. The first focus group discussions aimed at assessing the extent to which patients (N=5) or therapists (N=6) adapted the protocol. The second focus group discussions aimed at estimating the extent to which the therapy protocol is applied and personalized based on findings from the first focus groups to gain further qualitative insight into the reasons for personalization with groups of therapists and patients together (N=7). Qualitative data were analyzed using thematic analysis. Results: Therapists used the protocol as a ?toolbox? comprising different therapy tools, and personalized the protocol to enhance the therapeutic alliance and based on their therapy-provision experiences. Therapists estimated that they strictly follow 48% of the protocol, adapt 30%, and replace 22% by other nonprotocol therapeutic components. Patients personalized their own therapy to conform the assignments to their daily lives and routines, and to reduce their levels of stress and worry. Patients estimated that 29% of the provided therapy had been strictly followed by the therapist, 48% had been adjusted, and 23% had been replaced by other nonprotocol therapeutic components. Conclusions: A standard cognitive behavioral therapy protocol is not strictly and fully applied but is mainly personalized. Based on these results, the following recommendations for eHealth designers are proposed to enhance alignment of eHealth to therapeutic practice and implementation: (1) study and copy at least the applied parts of a protocol, (2) co-design eHealth with therapists and patients so they can allocate the components that should be open for user customization, and (3) investigate if components of the therapy protocol that are not applied should remain part of the eHealth applied. To best generate this information, we suggest that eHealth designers should collaborate with therapists, patients, protocol developers, and mental health care managers during the development process. UR - https://formative.jmir.org/2020/5/e15568 UR - http://dx.doi.org/10.2196/15568 UR - http://www.ncbi.nlm.nih.gov/pubmed/32374271 ID - info:doi/10.2196/15568 ER - TY - JOUR AU - Mendes-Santos, Cristina AU - Weiderpass, Elisabete AU - Santana, Rui AU - Andersson, Gerhard PY - 2020/4/6 TI - Portuguese Psychologists' Attitudes Toward Internet Interventions: Exploratory Cross-Sectional Study JO - JMIR Ment Health SP - e16817 VL - 7 IS - 4 KW - attitudes KW - psychologists KW - e-mental health KW - internet interventions KW - Attitudes Toward Internet Interventions Survey (ATIIS) KW - Portugal KW - EU N2 - Background: Despite the significant body of evidence on the efficacy and cost-effectiveness of internet interventions, the implementation of such programs in Portugal is virtually non-existent. In addition, Portuguese psychologists? use and their attitudes towards such interventions is largely unknown. Objective: The aim of this study was to explore Portuguese psychologists? knowledge, training, use and attitudes towards internet interventions; to investigate perceived advantages and limitations of such interventions; identify potential drivers and barriers impacting implementation; and study potential factors associated to previous use and attitudes towards internet interventions. Methods: An online cross-sectional survey was developed by the authors and disseminated by the Portuguese Psychologists Association to its members. Results: A total of 1077 members of the Portuguese Psychologists Association responded to the questionnaire between November 2018 and February 2019. Of these, 37.2% (N=363) were familiar with internet interventions and 19.2% (N=188) considered having the necessary training to work within the field. 29.6% (N=319) of participants reported to have used some form of digital technology to deliver care in the past. Telephone (23.8%; N=256), e-mail (16.2%; N=175) and SMS (16.1%; N=173) services were among the most adopted forms of digital technology, while guided (1.3%; N=14) and unguided (1.5%; N=16) internet interventions were rarely used. Accessibility (79.9%; N=860), convenience (45.7%; N=492) and cost-effectiveness (45.5%; N=490) were considered the most important advantages of internet interventions. Conversely, ethical concerns (40.7%; N=438), client?s ICT illiteracy (43.2%; N=465) and negative attitudes towards internet interventions (37%; N=398) were identified as the main limitations. An assessment of participants attitudes towards internet interventions revealed a slightly negative/neutral stance (Median=46.21; SD=15.06) and revealed greater acceptability towards blended treatment interventions (62.9%; N=615) when compared to standalone internet interventions (18.6%; N=181). Significant associations were found between knowledge (?24=90.4; P<.001), training (?24=94.6; P<.001), attitudes (?23=38.4; P<.001) and previous use of internet interventions and between knowledge (?212=109.7; P<.001), training (?212=64.7; P<.001) and attitudes towards such interventions, with psychologists reporting to be ignorant and not having adequate training in the field, being more likely to present more negative attitudes towards these interventions and not having prior experience in its implementation. Conclusions: This study revealed that most Portuguese psychologists are not familiar with and have no training or prior experience using internet interventions and had a slightly negative/neutral attitude towards such interventions. There was greater acceptability towards blended treatment interventions compared to standalone internet interventions. Lack of knowledge and training were identified as the main barriers to overcome, underlining the need of promoting awareness and training initiatives to ensure internet interventions successful implementation. UR - https://mental.jmir.org/2020/4/e16817 UR - http://dx.doi.org/10.2196/16817 UR - http://www.ncbi.nlm.nih.gov/pubmed/32250273 ID - info:doi/10.2196/16817 ER -