Developing an inclusive technological toolkit to support prevention approaches

Within this project, a technological toolkit is being developed, which will allow young people, mediated by caregivers, to create customizable applications to support their own mental health and wellbeing, based on evidence-based interventions.

The necessity for this project emerges out of two intertwined problems. First, the homogenous nature of existing approaches to promote youth mental health (YMH), as they are often text-based, even as they are progressively being translated into the digital sphere. Yet the group “adolescents”, which is, within this project, defined as youth roughly between the age of 14 and 25, can’t be considered homogenous by any sensible metric. An intervention which is highly engaging for one might be of no interest, or not even accessible, for another (Castro, Barrera, & Martinez, 2004). For example, the existing emphasis on text-based measures to promote mental health does exclude migrant youth who do not yet have access to the language in which those measures are presented. While an increasingly broad landscape of more heterogeneous YMH interventions is currently opening up, those interventions are usually not customizable, which results in the same exclusion effects, and in resting the burden of identifying a suitable intervention on the ability and willingness of adolescents to comb through all available options, until they find one that works for them. On top of that, for YMH interventions to be used in the first place, they have to be engaging, which Hagen, Collin, Metcalf, Rahilly, & Swainston (2012) point out as one of the key challenges when developing technological YMH interventions. Second, the aforementioned lack of available customization presents a lost opportunity to address hedonic adaptation (Kahneman, Diener, & Schwarz, 1999). Engagement decreases over time, as applications lose their novelty. This loss of engagement does not, however, coincide necessarily with decrease in usefulness or effectiveness. People may lose interest over time, even if continued use of an application would still be beneficial. Allowing for customization, for changing features of an application, allowing adding and removing of features, should decrease the effects of hedonic adaption, or at least delay them, and thus extend the period of active use of an application, which in turn likely increases the overall effect an YMH application can have on its user.

A review of relevant literature showed no existing publications or projects which were or are trying to create something like the technological toolkit proposed in this research plan. There is, however, a number of digital mental health interventions for both prevention and treatment purposes. Hollis et al. (2017) were able to identify 147 distinct digital health interventions, which were mainly based on computer, smartphones, internet and text messages as delivery mechanisms and predominantly, albeit not exclusively, address depression and anxiety. Clarke, Kuosmanen & Barry (2015) conclude a review of existing mental health technologies by pointing out the effectiveness of specifically module-based interventions for promotion of mental health. Silverstone et al. (2016) conclude a review of existing mental health technologies also by recommending a stronger use of multimodal solutions. Spijkerman, Pots & Bohlmeijer (2016) reviewed 15 randomized control trials, specifically for the effectiveness of online mindfulness-based interventions and conclude a significant effect on mental health.

The following key research questions are being addressed:

  1. Which set of interventions could be re-interpreted using multimodal and non-language based approaches and thus improve inclusiveness of YMH technology?
  2. Which set of modalities for input and output may be used for improving inclusiveness of YMH technology?
  3. How could a platform, making use of multimodal input and output, and also offering interchangeable, customizable components, look like?
  4. What would be a suitable user interface, offering usability and positive user experience, and sufficient guidance in how and what to select, to enable both direct use, as well as use mediated by caregivers?

Resources:

  • Budde, R., Kautz, K., Kuhlenkamp, K., & Züllighoven, H. (1992). Prototyping. In Prototyping (pp. 33–46). Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-76820-0_5
  • Buxton, B. (2010). Sketching User Experiences: Getting the Design Right and the Right Design. Morgan Kaufmann.
  • Castro, F. G., Barrera, M., & Martinez, C. R. (2004). The cultural adaptation of prevention interventions: resolving tensions between fidelity and fit. Prevention Science: The Official Journal of the Society for Prevention Research, 5(1), 41–45.
  • Certificate in Young People’s Mental Health and Technology. (n.d.). Retrieved July 5, 2017, from https://www.orygen.org.au/Skills-Knowledge/Resources-Training/Training-Modules/Paid/Certificate-in-YMHTech
  • Clarke, A. M., Kuosmanen, T., & Barry, M. M. (2015). A Systematic Review of Online Youth Mental Health Promotion and Prevention Interventions. Journal of Youth and Adolescence, 44(1), 90–113. https://doi.org/10.1007/s10964-014-0165-0
  • Hagen, P., Collin, P., Metcalf, A., Rahilly, K., & Swainston, N. (2012). Participatory Design of evidence-based online youth mental health promotion, intervention and treatment.
  • Hollis, C., Falconer, C. J., Martin, J. L., Whittington, C., Stockton, S., Glazebrook, C., & Davies, E. B. (2017). Annual Research Review: Digital health interventions for children and young people with mental health problems - a systematic and meta-review. Journal of Child Psychology and Psychiatry, 58(4), 474–503. https://doi.org/10.1111/jcpp.12663
  • Kahneman, D., Diener, E., & Schwarz, N. (1999). Well-being: Foundations of hedonic psychology. Russell Sage Foundation.
  • Kensing, F., & Blomberg, J. (1998). Participatory Design: Issues and Concerns. Computer Supported Cooperative Work (CSCW), 7(3–4), 167–185. https://doi.org/10.1023/A:1008689307411
  • Kvale, S. (2008). Doing Interviews. SAGE.
  • Muller, M. J., & Kuhn, S. (1993). Participatory Design. Commun. ACM, 36(6), 24–28. https://doi.org/10.1145/153571.255960
  • Schuler, D., & Namioka, A. (1993). Participatory Design: Principles and Practices. CRC Press.
  • Silverstone, P. H., Suen, V. Y., Ashton, C. K., Hamza, D. M., Martin, E. K., & Rittenbach, K. (2016). Are Complex Multimodal Interventions the Best Treatments for Mental Health Disorders in Children and Youth? Journal of Child and Adolescent Behavior, 4(4). https://doi.org/10.4172/2375-4494.1000305
  • Spijkerman, M. P. J., Pots, W. T. M., & Bohlmeijer, E. T. (2016). Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review, 45, 102–114. https://doi.org/10.1016/j.cpr.2016.03.009
  • Spradley, J. P. (2016). Participant Observation. Waveland Press.
  • Webster, J., & Watson, R. T. (2002). Analyzing the Past to Prepare for the Future: Writing a Literature Review. MIS Quarterly, 26(2), xiii–xxiii.

Team: Geraldine Fitzpatrick, Petr Slovak, Toni Michel

Partners: Medical University of Vienna, Anna Freud Centre in London