An Evaluation of the Effectiveness of Digital Health Technology to support Mental Health and Well-being

背景：数字健康技术在支持心理健康和福祉方面具有巨大潜力。它正变得越来越容易获得和接受，与面对面的干预相比有很大的好处，包括更高的成本效益、更广泛的覆盖范围和减少寻求支持的障碍。除了支持普通人群的心理健康和福祉外，特别可能从数字心理健康和福祉支持中受益的群体是自闭症患者(包括具有高度自闭症特征的成年人，自认为自闭症患者)。自闭症患者的心理健康和幸福感水平明显下降，在社交和面对面互动方面也面临着进一步的挑战。一个关键的问题是，心理健康和幸福感应用程序如何有效地工作，以及为谁服务。重要的是要确定什么是有效参与，以达到干预的预期结果。先前的研究表明，不同干预措施和不同人群的有效参与模式可能不同。因此，需要进行深入的使用分析，以评估数字心理健康和福祉支持的有效性。第二个关键问题是，为什么心理健康应用程序不起作用，以及针对谁。尽管数字心理健康和福祉支持具有潜力，但它受到高水平的辍学和“非使用损耗”(不能持续参与干预的人)的阻碍。了解非使用损耗是至关重要的(例如，干预措施是否被充分利用以达到预期结果，或者人们是否由于设计/开发问题而过早停止使用它？)研究目的和目的：目前的研究项目旨在评估数字健康技术支持心理健康和福祉的有效性。首先，对文献中报道的数字健康技术的优势和劣势进行调查。其次，将在普通人群以及明确界定的自闭症目标人群中评估数字心理健康和福祉支持应用程序(AIME-Health)的参与度。将使用以人为本的方法(PBA)对数字干预进行深入分析。PBA是一种迭代深入的数字干预开发定性方法。PBA引出并解决干预用户的需求和观点，将其作为干预发展的重要部分，确保干预将可用并吸引目标受众。这将增加参与度，并可能降低非使用损耗的风险。潜在的应用和好处：PBA将被应用于一种数字干预工具--Aim-Health，该工具目前正在由CyberLimbic Systems(该研究项目的部分资助者)开发。AIM-Health是一款智能手机应用程序(APP)，提供基于证据的心理健康和福祉支持。匿名数据将从应用程序中收集(符合GDPR)。与AIME-Health的合作将使该研究项目产生直接的社会影响。就如何更多地参与数字心理健康和福祉支持提供见解，有可能造福公众的心理健康和福祉，并减轻心理健康服务的压力。这直接符合ESRC概述的2020/30年度精神健康研究目标：为精神健康制定新的干预措施和支持，并改善选择和获得精神卫生保健的机会。此外，我们将利用应用自闭症研究中心(CAAR)与巴斯正念与同情中心(BCMC)之间的合作，以及BASS正念与同情中心、CAAR与人机交互研究小组之间的进一步新合作。随着像Aim-Health这样的智能应用程序大规模支持心理健康，这种合作在支持有效治疗方面变得越来越重要。

Context:Digital health technology has a great potential to support mental health and well-being. It is becoming increasingly accessible and acceptable and has substantial benefits over face-to-face interventions, including higher cost-effectiveness, wider reach, and reduced support-seeking barriers. Alongside supporting mental health and well-being in the general population, a population group that could particularly benefit from digital mental health and well-being support is autistic people (including adults with high levels of autistic traits, self-identifying as autistic). Autistic people experience significantly poorer levels of mental health and well-being and further challenges in social communication and face-to-face interaction.A crucial question is how mental health and well-being apps work effectively, and for whom. It is important to determine what constitutes effective engagement to reach the intervention's desired outcomes. Previous research has shown that effective engagement patterns can differ across interventions and populations. Therefore, an in-depth usage analysis to evaluate the effectiveness of digital mental health and well-being support is needed.A second crucial question is why mental health apps do not work, and for whom. Despite the potential of digital mental health and well-being support, it is impeded by high levels of drop-out and 'non-usage attrition' (people not sustaining engagement with an intervention). It is crucial to understand non-usage attrition (e.g. has the intervention been used sufficiently to reach its desired outcomes or have people stopped using it prematurely due to design/development issues?). Research aims and objectives:The current research project aims to evaluate the effectiveness of digital health technology to support mental health and well-being. Firstly, the strengths and weaknesses of digital health technology reported in the literature will be investigated. Secondly, engagement with a digital mental health and well-being support app (AIME-Health) will be evaluated in the general population as well as in a well-defined target autistic population.An in-depth analysis of a digital intervention will be conducted using the Person-Based Approach (PBA). The PBA is an iterative in-depth qualitative approach to digital intervention development. PBA elicits and addresses the needs and perspectives of an intervention user as a vital part of the intervention development, ensuring the intervention will be usable and engaging to its target audience. This will increase engagement and could reduce the risk of non-usage attrition.Potential applications and benefit:The PBA will be applied to a digital intervention 'AIME-Health', which is currently being developed by Cyberlimbic systems (partial funders of the research project). AIME-health is a smartphone application ('app') providing evidence-based mental health and well-being support. Anonymised data will be collected from the app (compliant with GDPR). The collaboration with AIME-Health will allow for the research project to have a direct societal impact. Providing insights into ways to increase engagement in digital mental health and well-being support has the potential to benefit public mental health and well-being and reduce pressure on mental health services. This fits directly with ESRC outlined mental health research goals 2020/30: to develop new interventions and support for mental health and to improve choice and access to mental health care. Additionally, we will employ a collaboration between the Centre for Applied Autism Research (CAAR) and the Bath Centre for Mindfulness and Compassion (BCMC), and further new collaboration between BCMC, CAAR and the Human Computer Interaction (HCI) Research Group. As intelligent apps like AIME-health support mental health at scale such collaborations are increasingly important in underpinning effective treatment.