Effective Techniques in Coronary Heart Disease Interventions: A meta-analysis (Preprint)

BACKGROUND Coronary heart disease (CHD) is a major cause of death worldwide. OBJECTIVE In this research, we investigated the effectiveness of digital interventions designed for the prevention and management of CHD. METHODS We searched three academic databases for scientific papers on CHD and digital interventions from 2004 to 2020, yielding 1706 papers and 1556 papers after deduplication. We further screened the titles and abstracts, excluding irrelevant papers, leaving 28 papers. A further nine papers were retrieved and included in the analysis through forward and backward referencing. We conducted meta-analysis using 13 of the 37 papers that fit the criteria for meta-analysis. We identified and classified intervention features using the Persuasive Systems Design model. Our findings show that digital health interventions had an impact on all clinical outcomes except Body Mass Index. RESULTS We present (1) intervention features that were associated with positive clinical outcomes, and (2) successful and unsuccessful interventions and the persuasive software features incorporated in them. Reminders, verifiability, social role, expertise, authority, tailoring, personalization, self-monitoring, praise, suggestion, and social learning principles were incorporated in interventions that succeeded in improving clinical outcomes. CONCLUSIONS Our research provides insights into persuasive software features that maintain powers to influence the effectiveness of CHD behavior change interventions.

Digital Health Interventions by Clinical Pharmacists: A Systematic Review

Integrating digital interventions in healthcare has gained increasing popularity among clinical pharmacists (CPs) due to advances in technology. The purpose of this study was to systematically review CP-led digital interventions to improve patients’ health-related clinical outcomes. PubMed and the Cochrane Database were searched to select studies that had conducted a randomized controlled trial to evaluate clinical outcomes in adults following a CP-led digital intervention for the period from January 2005 to August 2021. A total of 19 studies were included in our analysis. In these 19 studies, the most commonly used digital intervention by CPs was telephone use (n = 15), followed by a web-based tool (n = 2) and a mobile app (n = 2). These interventions were provided to serve a wide range of purposes in patients’ outcomes: change in lab values (e.g., blood pressure, HbA1c) (n = 23), reduction in health service use (n = 8), enhancing adherence (n = 6), improvement in drug-related outcomes (n = 6), increase in survival (n = 3), and reduction in health-related risk (e.g., CVD risk) (n = 2). Although the impacts of telephone-based interventions on patients’ outcomes were decidedly mixed, web-based interventions and mobile apps exerted generally positive influences. To date, little research has investigated the cost-effectiveness of digital interventions. Future studies are warranted.

Digital Interventions for Dual Diagnosis

Dual diagnosis is a leading contributor of disease burden worldwide. Whilst integrated treatment is recommended, there are considerable barriers that may inhibit access to integrated care, including a lack of training and resources. Digital interventions may enable access to support, providing a space for people to engage in treatment when they need it most. This chapter reviews the current literature on the efficacy of digital interventions for dual diagnosis. Computer-based interventions were effective at improving dual diagnosis outcomes; however, the combined effect of computer-based interventions and therapist support was found to be more effective than the effects of computer-based interventions alone. The evidence-base around smartphone applications is lacking, and there are perceived difficulties with this technology in addressing the complexity of issues faced by people with dual diagnosis. Future research should include standardised terminology to describe techniques used within interventions and consider a variety of research methods to understand implementation.

Monitoring Australian parents’ shifting receptiveness to digital mental health interventions during the COVID-19 pandemic

Background: Nascent evidence indicates that the mental health of parents and children has markedly declined during the COVID-19 pandemic. Considering disruptions to traditional face-to-face mental health services resultant from stay-at-home orders, the potential value of digital mental health interventions has become extremely apparent. Despite this, uptake of digital interventions remains poor, indicating that a better understanding is needed of factors that determine a willingness to use digital platforms. Method: The present multi-wave, longitudinal study of 2365 Australian parents explored between-person and within-person predictors of intentions to use digital interventions during the pandemic. Results: More than one-third of parents reported likely use of a self-guided and therapist-guided digital intervention, with the most endorsed reason for use being to support their child’s mental health. Between-person baseline predictors of higher intention ratings were parent’s prior mental illness, not living with a partner and recent environmental stressors. Within-person predictors of higher intention ratings were endorsement of mindful parenting strategies, child access to the Internet, better perceived management of child’s education, lower social support and financial hardship. Conclusion: Findings demonstrate that willingness to engage in digital interventions fluctuates in response to changing circumstances. Identifying novel ways to increase acceptance and uptake of digital interventions based on modifiable predictors established here is needed to realize the full potential of these modes of care in times of need.

Centering Lived Experience in Developing Digital Interventions for Suicide and Self-injurious Behaviors: User-Centered Design Approach

Background The prevalence of self-injurious thoughts and behaviors (SITB) signals a growing public health crisis. Despite a recognized need for improved and scalable interventions, the field of SITB intervention faces several challenges: existing interventions are often time and resource intensive, most individuals with SITB do not seek formal mental health care, and efficacious treatments are characterized by small effects. Combined, these challenges indicate a need for improved SITB interventions for individuals in formal treatment and those who are not treatment engaged but are at high risk of worsening mental health and future suicide attempts. Objective We present a methodological approach and set of techniques that may address these challenges by centering the lived experience of individuals with SITB in the process of developing needed services: user-centered design (UCD). Methods We highlight the value of UCD in the context of digital interventions for SITB by describing the UCD approach and explicating how it can be leveraged to include lived experience throughout the development and evaluation process. We provide a detailed case example highlighting 3 phases of the early development process that can be used to design an intervention that is engaging and meets end-user needs. In addition, we point to novel applications of UCD to complement new directions in SITB research. Results In this paper, we offer a 2-pronged approach to meet these challenges. First, in terms of addressing access to effective interventions, digital interventions hold promise to extend the reach of evidence-based treatments outside of brick-and-mortar health care settings. Second, to address challenges related to treatment targets and engagement, we propose involving individuals with lived experience in the design and research process. Conclusions UCD offers a well-developed and systematic process to center the unique needs, preferences, and perceived barriers of individuals with lived SITB experience in the development and evaluation of digital interventions.