Strategies for mHealth Research: Lessons from 3 Mobile Intervention Studies

  • Dror Ben-Zeev
  • Stephen M. Schueller
  • Mark Begale
  • Jennifer Duffecy
  • John M. Kane
  • David C. Mohr
Original Article

Abstract

The capacity of Mobile Health (mHealth) technologies to propel healthcare forward is directly linked to the quality of mobile interventions developed through careful mHealth research. mHealth research entails several unique characteristics, including collaboration with technologists at all phases of a project, reliance on regional telecommunication infrastructure and commercial mobile service providers, and deployment and evaluation of interventions “in the wild”, with participants using mobile tools in uncontrolled environments. In the current paper, we summarize the lessons our multi-institutional/multi-disciplinary team has learned conducting a range of mHealth projects using mobile phones with diverse clinical populations. First, we describe three ongoing projects that we draw from to illustrate throughout the paper. We then provide an example for multidisciplinary teamwork and conceptual mHealth intervention development that we found to be particularly useful. Finally, we discuss mHealth research challenges (i.e. evolving technology, mobile phone selection, user characteristics, the deployment environment, and mHealth system “bugs and glitches”), and provide recommendations for identifying and resolving barriers, or preventing their occurrence altogether.

Keywords

Mobile Health (mHealth) e-Health Mobile interventions Schizophrenia Depression Primary care 

References

  1. Andersson, G., Bergström, J., Holländare, F., Carlbring, P., Kaldo, V., & Ekselius, L. (2005). Internet-based self-help for depression: Randomised controlled trial. The British Journal of Psychiatry, 187, 456–461.CrossRefPubMedGoogle Scholar
  2. Bardram, J. E., Frost, M., Szántó, K., Faurholt-Jepsen, M., Vinberg, M., & Kessing, L. V. (2013). Designing mobile health technology for bipolar disorder: A field trial of the MONARCA system. In Proceedings of the 31st ACM International Conference on Human Factors in Computing Systems, CHI 2013 (pp. 2627–2638), Paris, France. doi:10.1145/2470654.2481364.
  3. Beck, K. (2003). Test-driven development: By example. Boston, MA: Addison-Wesley Professional.Google Scholar
  4. Ben-Zeev, D. (2012). Mobile technologies in the study, assessment, and treatment of schizophrenia. Schizophrenia Bulletin, 38, 384–385.CrossRefPubMedCentralPubMedGoogle Scholar
  5. Ben-Zeev, D., Brenner, C. J., Begale, M., Duffecy, J., Mohr, D. C., & Mueser, K. T. (2014). Feasibility, acceptability, and preliminary efficacy of a smartphone intervention for schizophrenia. Schizophrenia Bulletin. doi:10.1093/schbul/sbu033.PubMedGoogle Scholar
  6. Ben-Zeev, D., Davis, K., Kaiser, S., Krzos, I., & Drake, R. E. (2013a). Mobile technologies among people with serious mental illness: Opportunities for future services. Administration and Policy in Mental Health and Mental Health Services Research, 40, 340–343.CrossRefPubMedCentralPubMedGoogle Scholar
  7. Ben-Zeev, D., Drake, R. E., Corrigan, P. W., Rotondi, A. J., Nilsen, W., & Depp, C. (2012). Using contemporary technologies in the assessment and treatment of serious mental illness. American Journal of Psychiatric Rehabilitation, 15, 357–376.CrossRefGoogle Scholar
  8. Ben-Zeev, D., Kaiser, S. M., Brenner, C. J., Begale, M., Duffecy, J., & Mohr, D. C. (2013b). Development and usability testing of FOCUS: A smartphone system for self-management of schizophrenia. Psychiatric Rehabilitation Journal, 36, 289–296.CrossRefPubMedGoogle Scholar
  9. Burns, M. N., Begale, M., Duffecy, J., Gergle, D., Karr, C. J., Giangrande, E., et al. (2011). Harnessing context sensing to develop a mobile intervention for depression. Journal of Medical Internet Research, 13, e55.CrossRefPubMedCentralPubMedGoogle Scholar
  10. Carlbring, P., Nilsson-Ihrfelt, E., Waara, J., Kollenstam, C., Buhrman, M., Kaldo, V., et al. (2005). Treatment of panic disorder: Live therapy vs. self-help via the Internet. Behaviour Research and Therapy, 43, 1321–1333.CrossRefPubMedGoogle Scholar
  11. Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7–18.CrossRefPubMedGoogle Scholar
  12. Cohn, M. (2004). User stories applied: For agile software development. Boston, MA: Addison-Wesley Professional.Google Scholar
  13. Cohn, M. (2005). Agile estimating and planning. Boston, MA: Addison-Wesley Professional.Google Scholar
  14. Collins, L. M., Baker, T. B., Mermelstein, R. J., Piper, M. E., Jorenby, D. E., Smith, S. S., et al. (2011). The multiphase optimization strategy for engineering effective tobacco use interventions. Annals of Behavioral Medicine, 41, 208–226.CrossRefPubMedCentralPubMedGoogle Scholar
  15. Eyrich-Garg, K. M. (2010). Mobile phone technology: A new paradigm for the prevention, treatment, and research of the non-sheltered “street” homeless? Journal of Urban Health, 87, 365–380.CrossRefPubMedCentralPubMedGoogle Scholar
  16. Faurholt-Jepsen, M., VInberg, M., Christensen, E. M., Frost, M., Bardram, J., & Kessing, L. V. (2013). Daily electronic self-monitoring of subjective and objective symptoms in bipolar disorder—the MONARCA trial protocol (MONitoring, treatment and pRediCtion of bipolar disorder episodes): A randomised controlled single-blind trial. BMJ Open, 3, e003353.CrossRefPubMedCentralPubMedGoogle Scholar
  17. Harrison, V., Proudfoot, J., Wee, P. P., Parker, G., Pavlovic, D. H., & Manicavasagar, V. (2011). Mobile mental health: Review of the emerging field and proof of concept study. Journal of Mental Health (Abingdon, England), 20, 509–524.CrossRefGoogle Scholar
  18. Hekler, E. B., Klasnja, P., Froehlich, J., & Buman, M. (2013). Mind the theoretical gap: Interpreting, using, and developing behavioral theory in HCI research. In Proceedings of the 31st ACM International Conference on Human Factors in Computing Systems, CHI 2013 (pp. 3307–3316), Paris, France. doi:10.1145/2470654.2466452.
  19. Heron, K. E., & Smyth, J. M. (2010). Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments. British Journal of Health Psychology, 15, 1–39.CrossRefPubMedCentralPubMedGoogle Scholar
  20. ITU. (2011). The world in 2011: ICT facts and figures. Retrieved from http://www.itu.int/en/ITU-D/Statistics/Documents/facts/ICTFactsFigures2011.pdf.
  21. ITU. (2013). The world in 2013: ICT facts and figures. Retrieved from http://www.itu.int/en/ITU-D/Statistics/Documents/facts/ICTFactsFigures2013.pdf.
  22. Kaplan, R. M., & Stone, A. A. (2013). Bringing the laboratory and clinic to the community: Mobile technologies for health promotion and disease prevention. Annual Review of Psychology, 64, 471–498.CrossRefPubMedGoogle Scholar
  23. Klasnja, P., Consolvo, S., & Pratt, W. (2011). In Proceedings of the 29th ACM International Conference on Human Factors in Computing Systems, CHI 2011 (pp. 3063–3072), Vancouver, BC, Canada. doi:10.1145/1978942.1979396.
  24. Kumar, S., Nilsen, W. J., Abernethy, A., Atienza, A., Patrick, K., & Swendeman, D. (2013). Mobile health technology evaluation: The mHealth evidence workshop. American Journal of Preventive Medicine, 45, 228–236.CrossRefPubMedCentralPubMedGoogle Scholar
  25. Luxton, D. D., McCann, R. A., Bush, N. E., Mishkind, M. C., & Reger, G. M. (2011). mHealth for mental health: Integrating smartphone technology in behavioral healthcare. Professional Psychology: Research and Practice, 42, 505–512.CrossRefGoogle Scholar
  26. Marsch, L. A., & Ben-Zeev, D. (2012). Technology-based assessments and interventions targeting psychiatric and substance use disorders: Innovations and opportunities. Journal of Dual Diagnosis, 8, 259–261.CrossRefGoogle Scholar
  27. Martin, R. C. (2003). Agile software development: Principles, patterns, and practices. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
  28. Mohr, D. C., Cheung, K., Schueller, S. M., Brown, C. H., & Duan, N. (2013). Continuous evaluation of evolving behavioral intervention technologies. American Journal of Preventive Medicine, 45, 517–523.CrossRefPubMedGoogle Scholar
  29. Pagliari, C. (2007). Design and evaluation in eHealth: Challenges and implications for an interdisciplinary field. Journal of Medical Internet Research, 9, e15.CrossRefPubMedCentralPubMedGoogle Scholar
  30. Proudfoot, J., Klein, B., Barak, A., Carlbring, P., Cuijpers, P., Lange, A., et al. (2011). Establishing guidelines for executing and reporting internet intervention research. Cognitive Behaviour Therapy, 40, 82–97.CrossRefPubMedGoogle Scholar
  31. Riley, W. T., Glasgow, R. E., Etheredge, L., & Abernethy, A. P. (2013). Rapid, responsive, relevant (R3) research: A call for a rapid learning health research enterprise. Clinical and Translational Medicine, 2, 1–6.CrossRefGoogle Scholar
  32. Rotondi, A. J., Sinkule, J., Haas, G. L., Spring, M. B., Litschge, C. M., Newhill, C. E., et al. (2007). Designing websites for persons with cognitive deficits: Design and usability of a psychoeducational intervention for persons with severe mental illness. Psychological Services, 4, 202–224.CrossRefGoogle Scholar
  33. Rounsaville, B. J., Caroll, K. M., & Onken, L. S. (2001). A stage model of behavioral therapies research: Getting started and moving on from stage I. Clinical Psychology: Science and Practice, 8, 133–142.Google Scholar
  34. Rudd, J., Stern, K., & Isensee, S. (1996). Low vs. high-fidelity prototyping debate. Interactions, 3, 76–85.CrossRefGoogle Scholar
  35. Schueller, S. M., Muñoz, R. F., & Mohr, D. C. (2013). Realizing the potential of behavioral intervention technologies. Current Directions in Psychological Science, 22, 478–483.CrossRefGoogle Scholar
  36. Smith, A. (2013). Pew internet and American life project: Smartphone Ownership 2013. Retrieved September 10, 2013 from http://pewinternet.org/Reports/2013/Smartphone-Ownership-2013.aspx.
  37. Vogel, A. L., Hall, K. L., Fiore, S. M., Klein, J. T., Bennett, L. M., Gadlin, H., et al. (2013). The team science toolkit: Enhancing research collaboration through online knowledge sharing. American Journal of Preventive Medicine, 45, 787–789.CrossRefPubMedGoogle Scholar
  38. Wichansky, A. M. (2000). Usability testing in 2000 and beyond. Ergonomics, 43, 998–1006.CrossRefPubMedGoogle Scholar
  39. World Health Organization. (2011). Global Observatory for eHealth series—Volume 3: mHealth: New horizons for health through mobile technologies. Geneva, Switzerland: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Dror Ben-Zeev
    • 1
  • Stephen M. Schueller
    • 2
  • Mark Begale
    • 2
  • Jennifer Duffecy
    • 2
  • John M. Kane
    • 3
  • David C. Mohr
    • 2
  1. 1.Dartmouth Psychiatric Research CenterGeisel School of Medicine at DartmouthLebanonUSA
  2. 2.Department of Preventive Medicine, Center for Behavioral Intervention TechnologiesNorthwestern UniversityChicagoUSA
  3. 3.The Zucker Hillside Hospital, Psychiatry ResearchNorth Shore-Long Island Jewish Health SystemGlen OaksUSA

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