Digit Health 2019 Dec 16;5:2055207619896145 [, Frieden TR. Higher GAD-7 intake scores were also associated with decreased odds of improvement. Is JMIR Formative Research in PubMed yet? 1 to 5; 2017 to 2021; Vol. For example, we might consider looking more specifically and in greater depth at the frequency and intensity of coaching utilization and different patterns of coaching and clinical utilization (sequential vs concurrent). National Institute of Mental Health. A positive screen was defined as a response score for either question of 2 or greater (ie, a response of “more than half the days” or “nearly every day”). JMIR Medical Informatics (JMI, ISSN 2291-9694; Impact Factor: 2.58) (Editor-in-chief: Christian Lovis MD MPH FACMI) is a PubMed/SCIE-indexed journal that focuses on clinical informatics, big data in health and health care, decision support for health professionals, electronic health records, ehealth infrastructures and implementation.In June 2020, the journal received an impact factor of 2.58. JMIR Dermatology (JDerm) is a new sister journal of JMIR (the leading open-access journal in health informatics), focusing on technologies, medical devices, apps, engineering, informatics applications for patient education in dermatology, including preventative interventions (e.g. Objective: This study examines differences in anxiety outcomes by care modality (coaching, teletherapy and telepsychiatry, and combined care) within an on-demand mental health system. We also explore the association between levels of engagement within each care modality and odds of improvement in symptoms of anxiety. Kunkle, Manny Human support reduces this commonly observed engagement problem but does not consistently improve clinical and recovery outcomes. Udall D, <4 weeks of coaching, or the average days between interactions is ˃14 days, and <2 clinical sessions. The Oversell And Undersell Of Digital Health. We assessed the association between level of engagement and improvement within each modality, and we adjusted for baseline anxiety score with the reference group denoted as the “app-only” group (ie, those not engaged with a coach or clinician) as this is the lowest intensity intervention of all options. For this study, we included Ginger users aged 18 years or older who downloaded the app during the study data collection period and screened positive for anxiety on the 2-item Generalized Anxiety Disorder (GAD-2) intake survey. To facilitate ongoing efforts to develop human support for digital mental health technologies, this paper describes the design decisions, theoretical framework, content, mode, timing of delivery, and the training and supervision for coaching support of the LiveWell technology. Nierenberg, John A General Instructions for Authors for all JMIR journals (long form, valid for all JMIR journals) For journal-specific instructions, follow the "Author Guidelines" link in the footer of each journal homepage, e.g. These are members who are engaged with both a coach and clinician, meeting the criteria for both coaching and clinical engagement. Ann Intern Med 2007 Mar 06;146(5):317-325. Recovery rates in generalized anxiety disorder following psychological therapy: an analysis of clinically significant change in the STAI-T across outcome studies since 1990. Application of Synchronous Text-Based Dialogue Systems in Mental Health Interventions: Systematic Review. Diabetes is a highly prevalent long-term condition with high morbidity and mortality rates. Background: Anxiety is an extremely prevalent condition, and yet, it has received notably less attention than depression and other mental health conditions from a research, clinical, and public health perspective. Table 1 summarizes care modality categorization and rationale. Data were analyzed in Python and exported to spreadsheets for final analysis and review. Am J Health Promot 2015 May;29(5):e158-e168 [, Kivelä K, Elo S, Kyngäs H, Kääriäinen M. The effects of health coaching on adult patients with chronic diseases: a systematic review. Based on the coaching-only and clinical-only model specifications, we assigned the following values to calculate both a coach and clinical score: minimal=0, low=1, medium=2, and high=3. Adoption and evaluation of contact tracing tools based on information and communications technology may expand the reach and efficacy of traditional contact tracing methods in fighting COVID-19. 4 2020: v.4(1) 2020 Jan: v.4(2) 2020 Feb: v.4(3) 2020 Mar: v.4(4) 2020 Apr: v.4(5) 2020 May: v.4(6) 2020 Jun: v.4(7) 2020 Jul: v.4(8) 2020 Aug: v.4(9) 2020 Sep: v.4(10) 2020 Oct: v.4(11) 2020 Nov: v.4(12) 2020 Dec: Vol. Additionally, some serious and persistent mental illnesses require ongoing and chronic medication management and, thus, a longer treatment duration. We also had a relatively large amount of missing data for gender and age, which limited our ability to stratify analyses by key demographics. Our first set of models assesses the association between care modality and improvement. Community Health 2020 Apr 08;8(1):176-187. Similarly, in the United States, anxiety disorders are the most common mental health condition, but a large portion of those affected (36.9%) are estimated to go untreated [5]. in Despite effective pharmacological treatment, bipolar disorder is a leading cause of disability due to recurrence of episodes, long episode durations, and persistence of interepisode symptoms. Thus, this study examines differences in anxiety outcomes by care modality (coaching, teletherapy and telepsychiatry, and combined care) within an on-demand mental health system. Survey completion is not required so as not to withhold support from members who decline to answer the questions but are still interested in accessing the Ginger services. aOdds ratio obtained by exponentiation of the regression coefficients. Ξ, Dana Based on our inclusion criteria, 4369 individuals were eligible for this study. After adjusting for GAD-7 intake score, only the high utilization coefficient remained significant. Characteristics and predictors of full and partial recovery from generalized anxiety disorder in primary care patients. These evidence-based treatments have been effectively delivered as telemedicine offerings, with several systematic reviews indicating that treatment delivered in this manner increases access and reach to care [10-12]. VA Center for Integrated Healthcare (CIH). Formative research is research that occurs before a program is designed and implemented, or while a program is being conducted. They also tended to have higher levels of utilization within each modality and lower levels of anxiety at intake. Compared to the minimal-utilization reference group (those who sent less than 14 messages to a coach, engaged less than 4 weeks, or the average days between interactions were greater than 14 days), only the high-utilization group had significantly increased odds of improvement. ".It is the recommended abbreviation to be used for abstracting, indexing and referencing purposes and meets all criteria of the ISO 4 standard for abbreviating names of scientific journals.. However, there is a need to understand what is happening “in the wild” versus in controlled settings to understand if members are achieving expected outcomes, to further our understanding of how evidence-based interventions are implemented within new care delivery models, and to potentially uncover new areas for future study [18-20]. Naslund JA Association Between Care Utilization and Anxiety Outcomes in an On-Demand Mental Health System: Retrospective Observational Study JMIR Form Res 2021;5(1):e24662 doi: These results are shown graphically as probability of anxiety improvement by care modality and levels of intake severity in Figure 1. Finally, 12 sessions is generally considered the upper limit for the recommended course of treatment, although sessions may be extended for serious and persistent mental illnesses that require ongoing and chronic medication management. While the original focus was on the design of medical- and health-related research and technology innovations, JMIR Formative Research publishes studies from all areas of medical and health research. JMIR Formative Research publishes peer-reviewed, openly accessible papers containing results from process evaluations, feasibility/pilot studies and other kinds of formative research and preliminary results. Abstract: Background Cystic fibrosis (CF) is a rare, life-shortening, multiorgan disease, the treatment of which has seen significant increases in the life expectancy of those with CF. National Board for Health and Wellness Coaching. As there are many participant engagement challenges inherent in the design of large-scale community-based studies, adaptive and iterative participant engagement strategies are critical. The PARCS study, although ongoing, has developed several approaches to improve participant engagement: building trust with communities, adapting the study protocol to meet participants’ needs and to reflect their capacity for participation, operational flexibility, and developing tracking systems. Institute of Coaching. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. Med Care 2008 Mar;46(3):266-274. [, Sapra A, Bhandari P, Sharma S, Chanpura T, Lopp L. Using Generalized Anxiety Disorder-2 (GAD-2) and GAD-7 in a Primary Care Setting. This time period was chosen because it reflects the approximate timing of when Ginger began to provide care to members via its employer business. The COVID-19 pandemic has only exacerbated growing concerns about the burden of anxiety due to the confluence of physical health risks, economic stressors, social isolation, and general disruption of daily activities. For those users who had reported gender (560/1611, 34.5%), 371 (66.3%) were female and 187 (33.3%) were male. Data from the Centers for Disease Control and Prevention (CDC) show an increasing percentage of adults experiencing symptoms of anxiety disorder since early April; approximately 35% of adults reported symptoms of anxiety in July 2020 compared to 8.2% in January 2019 to June 2019 [8]. This app is based on a Google/Apple Exposure Notification approach and aims to combat the spread of the coronavirus among individuals by notifying those who are at increased risk of infection due to proximity to someone who later tests positive for COVID-19. 1 (2021): Med 2014 Jan 22;44(11):2363-2374. This can lead to poor diabetes control. January, 1Ginger, San Francisco, CA, United States, 2Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States, 3Massachusetts General Hospital, Boston, MA, United States, 4Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States. 10.2196/24662 Rare disease communities are spread around the globe and segmented by their condition. Minimal:less than 4 weeks, or the average days between interactions is greater than 14 days, Low:4-8 weeks, with average days between interactions <15 days, Medium:9-12 weeks, with average days between interactions <15 days, High:13+ weeks, with average days between interactions <15 days. Gen Hosp Psychiatry 2019 Jan;56:13-18 [. Additionally, due to the virtual nature of the system, we have detailed data on coaching utilization (eg, messaging volume and frequency) that likely would not exist for in-person care settings, and the ability to compare multiple modalities of care. 7872836, Copyright © URL: Rodriguez BF, Weisberg RB, Pagano ME, Bruce SE, Spencer MA, Culpepper L, et al. GAD Info Sheet. Results: Of 1611 Ginger members, 761 (47.0%) experienced a decrease in anxiety symptoms, as measured by a change from a positive to a negative 2-item Generalized Anxiety Disorder (GAD-2) screen. [, Marcelle ET, Nolting L, Hinshaw SP, Aguilera A. Future directions include more detailed classifications of utilization patterns and exploring explanations and solutions for lower utilization members. J Nerv Ment Dis 2006 Feb;194(2):91-97 [, Fisher PL, Durham RC. If we include the commonly accepted definition of a 5-point reduction in score, an additional 11.9% (192/1617) of the cohort would be classified as “improved.” Finally, we lack a control group to understand what would have happened in the absence of Ginger and to attribute causality, although we are able to understand these associations relative to defined reference groups. The abbreviation of the journal title "JMIR formative research" is "JMIR Form. Our data suggest that while all treatment modalities appeared to offer comparable benefits in managing anxiety, the largest effects were observed among those who engaged in services for at least 13 weeks of care. Edited by G Eysenbach; submitted 30.09.20; peer-reviewed by MW Haun; comments to author 22.10.20; revised version received 16.11.20; accepted 20.12.20; published 26.01.21. The most up-to-date impact factor news for JMIR journals is based on the Journal Citation Reports released in June 2020 in which JMIR received an impact factor of 5.03. A study by the World Health Organization (WHO) found that only a fifth (20.6%) of participants with an anxiety disorder sought help from health care services, and of those individuals who sought help, 23.2% received no treatment at all [1]. Data were collected from 1611 Ginger members between January 1, 2018, and December 31, 2019. Evaluation of an On-Demand Mental Health System for Depression Symptoms: Retrospective Observational Study. A preprint showed that as of April 2020, 1 out of 4 US adults meet the criteria for serious mental distress, 8 times more than a demographically similar sample from 2018 [7]. [, Andrews G, Basu A, Cuijpers P, Craske M, McEvoy P, English C, et al. This aligns with existing literature that finds that most forms of treatment are better than nothing, further highlighting the need to get even low-intensity treatments to individuals who need help. Hunt, Watson N Engl J Med 2017 Aug 03;377(5):465-475. Examples of situations that require escalation include individuals with chronic mental illness and severe trauma, the potential to harm oneself or others, and significant mental instability (hallucinations, delusions, extreme mood swings, etc). Can smartphone mental health interventions reduce symptoms of anxiety? A higher GAD-7 intake score was also associated with decreased odds of improvement. Data for this study were processed using Looker (Looker Data Sciences Inc), a business intelligence and data analytics platform. Arean, Andrew Yip M, When members are escalated to therapy or psychiatry, they may continue working with a coach, provided that they also seek additional specialized care concurrently. Of these 1611 individuals, 756 (46.9%) experienced a decrease in anxiety symptoms as measured by a change from a positive to a negative GAD-2 screen. 1 Iss. The amount of stroma in the primary tumor is an important prognostic parameter. We also found the largest effect size for the combined-care (coaching and clinical) group, suggesting that engaging in multiple levels of care might be more effective for treating anxiety. eHealth interventions might improve outcomes and decrease costs. This study found increased odds of anxiety improvement for all care modalities compared to those who did not engage in care, with larger effect sizes for higher utilization within all care modalities. Health coaching has also emerged as a potential solution to overcoming traditional shortages of specialist mental health providers. URL: Osenbach JE, O'Brien KM, Mishkind M, Smolenski DJ. Health Aff;(January) 2019:1-9. JAMA 2016 Aug 02;316(5):533-534. Dialogues Clin Neurosci 2015 Oct;17(3):327-335. A negative screen was defined as a response score for each question of less than 2 (ie, a response of “not at all” or “several days”). Another potential limitation is that we had to rely on GAD-2 rather than GAD-7 to assess anxiety symptom improvement. Individuals that score a 2 or above for either question are then prompted to complete the full GAD-7. Update: This is an archived post. A systematic review concluded that health coaching could motivate change in the lifestyle behavior of patients with chronic illness, leading to improvements in both physical and mental health status [15]. For each model, we also calculated the Hosmer-Lemeshow goodness-of-fit statistic [34]. Table 5 reports outputs for the model examining the association between utilization and anxiety symptom improvement for the clinical-only cohort. Members generally begin receiving active intervention during their second session. Recent studies focused on text-based coaching interventions have shown significant improvements in mental health outcomes equivalent to treatment as usual, namely, in-person and telephone counseling [16,17]. Among members who still screened positive at follow-up (855/1611, 53.1%), a total of 192 members (11.9%) experienced a clinically significant score reduction in the full GAD-7 (ie, a score reduction of ˃5 points), even though their GAD-2 scores were still positive. 33496679 Effectiveness of Online Collaborative Care for Treating Mood and Anxiety Disorders in Primary Care: A Randomized Clinical Trial. The COVID-19 pandemic hit the Netherlands at the end of February 2020, resulting in over 900,000 people testing positive for the virus, over 24,000 hospitalizations, and over 13,000 deaths by the end of January 2021. The tumor-stroma ratio (TSR) was previously validated by international research groups as a robust parameter with good interobserver agreement. URL: Introduction to the Coaching Profession. While limited in several ways, this design has an important benefit in not being constrained by the strict requirements for controlled clinical trials. Anxiety disorders, including generalized anxiety disorder, panic disorder, and various phobia-related disorders, are prevalent mental health conditions in the United States and globally; large population surveys have shown that about one-third of individuals are affected by an anxiety disorder during their lifetimes [1]. Psychol. This support includes clearly defined and structured roles that aim to encourage the use of the technology, self-management strategies, and communication with care providers. As Ginger members achieve improvements in their GAD scores, they could be moved to a lower level of intervention to ensure therapists are working at the “top of their license” and the system is efficiently using scarce clinical resources. A Hosmer-Lemeshow test failed to reject the null hypothesis, indicating goodness of fit, X2 (8, N=1611)=8.9, P=.35. Background: There is a persistent need for mental ill-health prevention and intervention among at-risk and vulnerable subpopulations. Within each modality, we assessed the association between level of engagement and improvement. Future directions include more detailed classifications of utilization patterns and an exploration of explanations and solutions for lower-utilization members. More specifically, coaching might provide an added benefit of longitudinal support toward goals between episodic clinical visits. Unfortunately, many mental health technology interventions suffer from high attrition rates, with users rapidly failing to maintain engagement with the intervention technology. MY conducted the data analysis. This study segues into many directions of future research. JMIR Formative Research Vols. Psychotherapy techniques include Cognitive Behavioral Therapy (CBT), which teaches people different ways of thinking, behaving, and reacting to anxiety-producing objects and situations. JMIR Formative Research has been accepted for indexing in PubMed and PubMed Central. Our authors do not (or should not) publish in JMIR Res Protoc (JRP) to get "impact factor brownie points". 2nd ed. Table 4 reports outputs for the model examining the association between utilization and anxiety symptom improvement for the text-based coaching-only cohort. The study team does not have access to participant identifying information and does not intend to recontact participants. See our COVID-19 Papers and Special Issues. Special additional article types for JMIR Research Protocols Early Reports Early reports, formative research articles (e.g. Centers for Disease Control and Prevention. Hunt J, Most patients who are affected by a rare disease have no research on their condition because of a lack of knowledge due to absence of common groups in the research community. JRP mainly publishes proposals or protocols. 5 2021: v.5(1) 2021 Jan: v.5(2) 2021 Feb: Vol. Table 2 shows descriptive characteristics of Ginger platform users, categorized by individuals who experienced a change in GAD screen (ie, from a positive screen to a negative follow-up screen) and those who did not (positive follow-up screen). (Preliminary results from pilot studies, early results, and formative research should now be published in JMIR Formative Research. This limits our ability to assess certain anxiety symptoms; however, GAD-2 represents 2 core anxiety symptoms and has been shown to have good sensitivity and specificity in the diagnosis of the most common anxiety disorders [4]. [, Safavi K, Cohen A. [. Depress Anxiety 2013 Nov 06;30(11):1058-1067. We also explore the association between levels of engagement within each care modality and odds of improvement in symptoms of anxiety. These strategies may help researchers anticipate and respond to participant engagement challenges in community-based studies, particularly in low-income communities of color. Papers with focus on games in health or gamification aspects of apps and theoretical issues/commentary on gaming are now primarily published in / transferred to JMIR … Compared to the minimal-utilization reference group (those who only attended 1 therapy session), those in the low, medium, and high utilization categories had increased odds of improvement, with odds ratios increasing ordinally with each category. Home Record. In general, this categorization allows us to understand associations by months of engagement, from less than a month (“minimal”) to more than 3 months (“high”). A Hosmer-Lemeshow test failed to reject the null hypothesis, indicating goodness of fit, X2 (8, N=349)=6.44, P=.50. Cancer-specific mobile health apps for patient-related outcomes allow patients to communicate with their clinicians and proactively track their symptoms, which have been shown to improve clinical management and disease outcomes. Other benefits of teletherapy include more convenient access, reduced stigma, and greater scalability compared with traditional in-person therapy [13]. J Med Internet Res 2011 Aug 05;13(3):e52 [, Fuhr K, Schröder J, Berger T, Moritz S, Meyer B, Lutz W, et al. Women and girls are at greater risk of insomnia, yet differences in treatment responsiveness between genders have not been adequately investigated. Originally published in JMIR Formative Research (http://formative.jmir.org), 26.01.2021. Skip to main content. 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The complete bibliographic information, a link to the original publication on http://formative.jmir.org, as well as this copyright and license information must be included. Additionally, while women report greater symptom severity and burden of illness than men, this discrepancy requires further examination in adolescents. These symptoms can occur very early in the disease progression and are often difficult to detect and quantify in nonspecialized clinical settings. The Support Through Mobile Messaging and Digital Health Technology for Diabetes (SuMMiT-D) study aims to deliver brief messages as tailored interventions to support people with type 2 diabetes in better use of their diabetes medicines and to improve treatment adherence and health outcomes. For example, Ginger clinical protocols state that maintenance and termination can be considered if there is a response by 4-8 weeks.
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