Conference Abstracts

Implementation of the mobile Health App Database (mHAD)

Eva-Maria Rathner, Yannick Terhorst, Rüdiger Pryss, Johannes Schobel, Manfred Reichert, Harald Baumeister,  University of Ulm, Germany

Introduction: Mobile devices are an integral part of daily life. Mobile Health apps (mHA) have the potential to support high need, high cost populations in managing their health. mHA reduce barriers to seek help and can be used irrespective of geographical, financial and social conditions. mHA can target non-clinical and clinical populations at the same time. So far, there are no platform for standardized expert quality ratings for mHA.

Aim: The mobile Health App Database (mHAD) enables a standardized expert quality rating of mHA to increase transparency and safety for users and patients. It provides decision support and advanced search options for users and health care professionals. The database is the foundation for systematic research of the efficacy of mHA in improvement and treatment of mental health.

Methods: The database is fed by a web-crawler. All available mHA and their updates are collected twice a year. Included mHA are rated with a modified version of the Mobile App Rating Scale (MARS) by two independent experts. The edited ratings are open accessible to users, patients and health care providers via website.

Results: mHA which are available in the German Google Play and iTunes store for depression (n=38/1156) and anxiety disorders (n=411/3563) were rated. An average quality (M=3.01, SD=0.56) of mHA and no correlation between App-store and MARS ratings were found. On average only 10% of available mHA can be recommended with limitations for health care usage.

Discussion: The workshop gives insight into the rating of mHA and provides a platform for expert discussion and networking. Participants should be enabled to discuss the main potential and problematic outcomes of mHA-usage. We want to sharpen the awareness for the need of standardized expert ratings, systematic research of efficacy and best practice guidelines for mHA development.



Agile product development methodologies for mental health apps: testing usability without a line of code

M. Goering, Mindrise Labs GmbH, Germany

The rapid growth in the use of smartphones has opened a new world of opportunities for scalable use in mental health care. Several e-/m-health programs have shown general effectiveness of such interventions, however very few programs master the challenges of disseminating to the broad public. A crucial problem lies in creating programs that users/patients engage with in real life, measured by retention rates. Many programs lack a user-centered design and sacrifice satisfying user experience for the sake of heavy-handed data-gathering and other objectives. A crucial competence in creating a program that can disseminate to the public is finding the balance between appealing product design and evidence based e-/m-health program development. Methodologies like Design Thinking and agile product development principles, paired with the availability of low-cost design and prototyping software allows a cost-effective way of ensuring usability and good user experience. This workshop will give an overview over these principles and a guideline on creating a testable prototype of a program, without hiring a single developer



Design of digital health interventions with the open source platform MobileCoach

T. Kowatsch*1, S. Haug2, A. Filler1 1Center for Digital Health Interventions, University of St.Gallen, Switzerland; 2Swiss Research Institute of Public Health and Addiction at Zurich University, Switzerland

Introduction: MobileCoach (www.mobile-coach.eu) is an open source behavioural intervention platform for scalable digital health interventions (DHIs). Based on personalized data streams, MobileCoach uses communication services (e.g. text-messaging) and sensor data (e.g. on physical activity) to monitor behaviour via ambulatory assessment techniques on a regular basis and to provide individual feedback. With its rule-based approach, MobileCoach guides participants based on explicit knowledge from domain experts (e.g. health psychologists and health professionals) with the help of a simple chat dialog in combination with interactive elements like games, health exercises or social challenges.

Methods: The workshop will consist of short presentations, live demonstrations and discussions (1) to provide an overview of the platform and various MobileCoach-based DHIs (e.g. in the context of physical activity, diet coaching, childhood obesity, problem drinking, life skills, intentional personality change and health literacy), (2) to showcase the design of DHIs with a focus on the intervention setup, costs, rule-based intervention flow, user management, simulation of interventions, intervention export and maintenance (3) to identify and discuss novel features and open research questions with the workshop participants and, (4) to motivate DHI designers to join the open source community and to exchange ideas about innovative DHIs and potential collaborations.

Results: Novel technical features will be gathered from the participants to guide the future development of the platform and thus to increase its adoption either by researchers for pilot studies and clinical trials or by healthcare professionals.

Discussion: Challenges at the intersection of research prototypes, i.e. not certified medical apps and certified DHIs will be discussed. It will be also discussed to which degree personalized data collected during clinical trials can be reused for certified DHIs by means of electronic health records, and other health data initiatives (e.g. midata.coop and healthbank.coop). Finally, open questions from the participants will be discussed.



Economic evaluations of internet-based/mobile mental health interventions: design, conduct and analysis
J.E Bosmans*, S. Kolovos, M.M. Riper, VU Amsterdam, Netherlands (for abstract page)

Introduction
: The demand for healthcare is infinite, while the resources available for healthcare are limited. This means that healthcare decision makers need to make decisions about how to most efficiently use these scarce resources. Economic evaluations are an invaluable tool to inform such decisions. This contribution gives an overview of the design, conduct and analysis of economic evaluations of internet-based/mobile mental health interventions.

Methods: A summary of the current recommendations for the design, conduct and analysis of economic evaluations is given with a specific focus on economic evaluations of internet-based/mobile mental health interventions.

Results: In an economic evaluation, the incremental costs of a new intervention as compared to control are related to the incremental effects. The control treatment should resemble usual care as much as possible to optimally inform decision makers. Economic evaluations can be conducted alongside randomised controlled trials or mathematical models. In all cases, care should be taken that all relevant costs are taken into account. Thus, not only mental care costs should be included, but also other healthcare costs and lost productivity costs. The effect of the intervention needs to be measured in clinical outcomes, but a comprehensive outcome reflecting overall wellbeing should be included as well. Quality-adjusted life-years are preferred as such a comprehensive outcome. The primary statistic of interest is the incremental cost-effectiveness ratio (ICER) which is calculated as the incremental costs divided by the incremental effects. Uncertainty surrounding ICERs is estimated using bootstrapping in trial-based economic evaluations and using Monte Carlo simulation techniques in model-based economic evaluations. Uncertainty is presented in cost-effectiveness planes and acceptability curves.

Discussion: Economic evaluations require specific methods. This overview will assist in improving the quality of economic evaluations of internet-based/mobile mental health interventions. As a result, quality of health care allocation decisions will be improved.



Increasing the impact of e/mhealth interventions: The Multiphase Optimization Strategy (MOST)
Linda Collins, Pennsylvania State University, USA

A more indepth look at the topics raised during Linda's keynote presentation
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