Accelerating Digital Mental Health Research From Early Design and Creation to Successful Implementation and Sustainment
Accelerating Digital Mental Health Research From Early Design and Creation to Successful Implementation and Sustainment
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DOI：
10.2196/jmir.7725
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发表时间：
2017-05-01
影响因子：
7.4
通讯作者：
Schueller, Stephen M.
中科院分区：
文献类型：
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作者：
Mohr, David C.;Lyon, Aaron R.;Schueller, Stephen M.
精神健康问题很常见，并在费用、发病率、生活质量和死亡率方面造成巨大的社会负担。绝大多数人都面临着无法获得治疗的障碍，而缺乏心理健康专家则加剧了这种障碍。数字心理健康可能有助于满足大量人的治疗需求。越来越多的疗效试验显示出数字心理健康治疗的强劲成果。然而，尽管有积极的发现，但成功实施的例子很少，失败的例子也很多。尽管研究与实践之间的差距并不是数字心理健康所独有的，但技术的融入带来了独特的挑战。我们概述了造成这种差距的一些原因，并提出了一系列可以实现可持续数字心理健康干预措施的方法。这些方法借鉴了人机交互和实施科学，并集成到加速创建到维持 (ACTS) 模型中。 ACTS 模型使用迭代过程，其中包括跨 3 个一般阶段（创建、试验和维持）的 2 个基本功能（设计和评估）。使用 ACTS 模型的最终目标是产生在现实世界的治疗环境中可持续的功能性技术支持服务（TES）。我们强调服务部分的重要性，因为研究和实践的证据表明，人际接触是最有效和最常用的数字心理健康治疗的关键要素。创建阶段至少会产生一个最低限度可行的 TES 和一个实施蓝图。试验阶段需要评估有效性和实施情况，同时允许 TES 和实施计划的优化和持续质量改进。最后，维持阶段涉及撤回研究或捐助者支持，同时保留正常运行、不断改进的 TES。 ACTS 模型是将实施和维持纳入 TES 的设计和评估、将公共卫生纳入临床研究、将研究纳入诊所以及将治疗纳入患者生活的一步。
Mental health problems are common and pose a tremendous societal burden in terms of cost, morbidity, quality of life, and mortality. The great majority of people experience barriers that prevent access to treatment, aggravated by a lack of mental health specialists. Digital mental health is potentially useful in meeting the treatment needs of large numbers of people. A growing number of efficacy trials have shown strong outcomes for digital mental health treatments. Yet despite their positive findings, there are very few examples of successful implementations and many failures. Although the research-to-practice gap is not unique to digital mental health, the inclusion of technology poses unique challenges. We outline some of the reasons for this gap and propose a collection of methods that can result in sustainable digital mental health interventions. These methods draw from human-computer interaction and implementation science and are integrated into an Accelerated Creation-to-Sustainment (ACTS) model. The ACTS model uses an iterative process that includes 2 basic functions (design and evaluate) across 3 general phases ( Create, Trial, and Sustain). The ultimate goal in using the ACTS model is to produce a functioning technology-enabled service TES) that is sustainable in a real-world treatment setting. We emphasize the importance of the service component because evidence from both research and practice has suggested that human touch is a critical ingredient in the most efficacious and used digital mental health treatments. The Create phase results in at least a minimally viable TES and an implementation blueprint. The Trial phase requires evaluation of both effectiveness and implementation while allowing optimization and continuous quality improvement of the TES and implementation plan. Finally, the Sustainment phase involves the withdrawal of research or donor support, while leaving a functioning, continuously improving TES in place. The ACTS model is a step toward bringing implementation and sustainment into the design and evaluation of TESs, public health into clinical research, research into clinics, and treatment into the lives of our patients.