This paper explores the reasons why particular online CoP for alcohol harm reduction hosted by the UK Health Forum failed to generate sufficient interest from the group of public health professionals at which it was aimed | Implementation Science
Improving mechanisms for knowledge translation (KT) and connecting decision-makers to each other and the information and evidence they consider relevant to their work remains a priority for public health. Virtual communities of practices (CoPs) potentially offer an affordable and flexible means of encouraging connection and sharing of evidence, information and learning among the public health community in ways that transgress traditional geographical, professional, institutional and time boundaries. The suitability of online CoPs in public health, however, has rarely been tested.
Quantitative and qualitative data confirm that the target audience had an interest in the kind of information and evidence the CoP was set up to share and generate discussion about, but also that participants considered themselves to already have relatively good access to the information and evidence they needed to inform their work. Qualitative data revealed that the main barriers to using the CoP were a proliferation of information sources meaning that participants preferred to utilise trusted sources that were already established within their daily routines and a lack of time to engage with new online tools that required any significant commitment.
The potential of digital technology to make the lives of people with mental health difficulties better has never been greater | The Mental Elf
The advent of the smartphone and mobile internet access has created the conditions for an ever-expanding range of opportunities for the use of technology to influence outcomes in health. However, ethical considerations remain for professionals in suggesting the use of such technologies.
Objective: To document the range of web and smartphone apps used and recommended for stress, anxiety or depression by the National Health Service (NHS) in England.
Results: A total of 61 (54.95%) out of the then 111 IAPT service providers responded, accounting for 191 IAPT services, and all 51 of the then NHS Mental Health Trusts responded. The results were that 13 different web apps and 35 different smartphone apps for depression, anxiety or stress were available through either referral services or the online NHS Apps Libraries. The apps used and recommended vary by area and by point of access (online library/IAPT/trust).
Conclusions: Future research is required to establish the evidence base for the apps that are being used in the NHS in England. There is a need for service provision to be based on evidence and established guidelines.
Edwards, E.A. et al. BMJ Open. 2016(6) e012447. Published online: 4 October 2016
Objective: Smartphone games that aim to alter health behaviours are common, but there is uncertainty about how to achieve this. We systematically reviewed health apps containing gaming elements analysing their embedded behaviour change techniques.
Methods: Two trained researchers independently coded apps for behaviour change techniques using a standard taxonomy. We explored associations with user ratings and price.
Data sources: We screened the National Health Service (NHS) Health Apps Library and all top-rated medical, health and wellness and health and fitness apps (defined by Apple and Google Play stores based on revenue and downloads). We included free and paid English language apps using ‘gamification’ (rewards, prizes, avatars, badges, leaderboards, competitions, levelling-up or health-related challenges). We excluded apps targeting health professionals.
Results: 64 of 1680 (4%) health apps included gamification and met inclusion criteria; only 3 of these were in the NHS Library. Behaviour change categories used were: feedback and monitoring (n=60, 94% of apps), reward and threat (n=52, 81%), and goals and planning (n=52, 81%). Individual techniques were: self-monitoring of behaviour (n=55, 86%), non-specific reward (n=49, 82%), social support unspecified (n=48, 75%), non-specific incentive (n=49, 82%) and focus on past success (n=47, 73%). Median number of techniques per app was 14 (range: 5–22). Common combinations were: goal setting, self-monitoring, non-specific reward and non-specific incentive (n=35, 55%); goal setting, self-monitoring and focus on past success (n=33, 52%). There was no correlation between number of techniques and user ratings (p=0.07; rs=0.23) or price (p=0.45; rs=0.10).
Conclusions: Few health apps currently employ gamification and there is a wide variation in the use of behaviour change techniques, which may limit potential to improve health outcomes. We found no correlation between user rating (a possible proxy for health benefits) and game content or price. Further research is required to evaluate effective behaviour change techniques and to assess clinical outcomes.
Tomlin, A. The Mental Elf Blog. Published online: 29 September 2016
NICE recommends a range of psychological and drug treatments for PTSD such as trauma-focused cognitive behavioural therapy, but does not recommend computer-based psychotherapies. A recent systematic review and meta-analysis from the Netherlands may persuade the guideline developers to think again.
The aim of this meta-analysis was to evaluate the effectiveness of Internet-delivered Cognitive Behavioural Therapy (iCBT) compared to inactive (waitlist control or treatment-as-usual) and active other interventions in reducing PTSD symptoms.
Overall, the results show that iCBT is superior to waitlist, with a trend suggesting that iCBT is more effective than active controls (e.g. psychoeducation and supportive counselling).
iCBT compared to waitlist or treatment as usual (11 comparisons from 10 studies of 1,139 participants) found a moderate pooled effect size (g = 0.71, 95% CI 0.49 to 0.93, P < .001) with moderate heterogeneity
iCBT compared to other interventions (3 comparisons from 3 studies) found a small pooled effect size (g = 0.28, 95% CI -0.00 to 0.56, P = .05) with low heterogeneity
The effects were strongest when iCBT interventions were therapist-assisted and longer than eight sessions. This echoes what we know from other web-based psychotherapy evidence.
When comparing iCBT to waitlist, visual inspection of the funnel plot and Egger’s test (P = .34) did not indicate the presence of publication bias.
Betton, V. The Mental Elf Blog. Published online: 27 September 2016
The use of digital technologies such as Internet sites and mobile applications, have received much hype in recent years, both in mental health and the NHS more widely. Opinions on these technologies vary; and those with extreme viewpoints see them as either a panacea to overstretched services or as undermining the primacy of the face-to-face patient/clinician relationship.
A recent open access study endeavoured to dig beneath the hype by seeking to understand the opportunities and challenges posed by the use of digital technologies from the perspective of mental health providers. As someone who runs an NHS digital innovation programme, I see how practitioners are often overlooked in the development process. This is a big problem because those same practitioners are often critical in influencing the take-up and use of digital technologies by patients. So understanding digital technologies from a practitioner perspective is a welcome addition to research in this field.
Hallgren, M. et al. (2016) The British Journal of Psychiatry. 209(3)
Background: Evidence-based treatment of depression continues to grow, but successful treatment and maintenance of treatment response remains limited.
Aims: To compare the effectiveness of exercise, internet-based cognitive–behavioural therapy (ICBT) and usual care for depression.
Method: A multicentre, three-group parallel, randomised controlled trial was conducted with assessment at 3 months (post-treatment) and 12 months (primary end-point). Outcome assessors were masked to group allocation. Computer-generated allocation was performed externally in blocks of 36 and the ratio of participants per group was 1:1:1. In total, 945 adults with mild to moderate depression aged 18–71 years were recruited from primary healthcare centres located throughout Sweden. Participants were randomly assigned to one of three 12-week interventions: supervised group exercise, clinician-supported ICBT or usual care by a physician. The primary outcome was depression severity assessed by the Montgomery–Åsberg Depression Rating Scale (MADRS).
Results: The response rate at 12-month follow-up was 84%. Depression severity reduced significantly in all three treatment groups in a quadratic trend over time. Mean differences in MADRS score at 12 months were 12.1 (ICBT), 11.4 (exercise) and 9.7 (usual care). At the primary end-point the group × time interaction was significant for both exercise and ICBT. Effect sizes for both interventions were small to moderate.
Conclusions: The long-term treatment effects reported here suggest that prescribed exercise and clinician-supported ICBT should be considered for the treatment of mild to moderate depression in adults.