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Using Computer Games to Support Mental Health Interventions: Naturalistic Deployment Study

BACKGROUND: Recent research has highlighted naturalistic uptake as a key barrier to maximizing the impact of mental health technologies. Although there is increasing evidence regarding the efficacy of digital interventions for mental health, as demonstrated through randomized controlled trials, ther...

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Autores principales: van der Meulen, Hidde, McCashin, Darragh, O'Reilly, Gary, Coyle, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707559/
https://www.ncbi.nlm.nih.gov/pubmed/31094346
http://dx.doi.org/10.2196/12430
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author van der Meulen, Hidde
McCashin, Darragh
O'Reilly, Gary
Coyle, David
author_facet van der Meulen, Hidde
McCashin, Darragh
O'Reilly, Gary
Coyle, David
author_sort van der Meulen, Hidde
collection PubMed
description BACKGROUND: Recent research has highlighted naturalistic uptake as a key barrier to maximizing the impact of mental health technologies. Although there is increasing evidence regarding the efficacy of digital interventions for mental health, as demonstrated through randomized controlled trials, there is also evidence that technologies do not succeed as expected when deployed in real-world settings. OBJECTIVE: This paper describes the naturalistic deployment of Pesky gNATs, a computer game designed to support cognitive behavioral therapy (CBT) for children experiencing anxiety or low mood. The objective of this deployment study was to identify how therapists use Pesky gNATs in real-world settings and to discover positive and negative factors. On the basis of this, we aimed to derive generalizable recommendations for the development of mental health technologies that can have greater impact in real-world settings. METHODS: Pesky gNATs has been made available through a not-for-profit organization. After 18 months of use, we collected usage and user experience data from therapists who used the game. Data were collected through an online survey and semistructured interviews addressing the expectations and experiences of both therapists and young people. Thematic analysis was used to identify key themes in the interview and survey data. RESULTS: A total of 21 therapists, who used Pesky gNATs with 95 young people, completed the online survey. Furthermore, 5 therapists participated in the follow-up interview. Confirming previous assessments, data suggest that the game can be helpful in delivering therapy and that young people generally liked the approach. Therapists shared diverse opinions regarding the young people for whom they deemed the game appropriate. The following 3 themes were identified: (1) stages of use, (2) impact on the delivery of therapy, and (3) customization. We discuss therapists’ reflections on the game with regard to their work practices and consider the question of customization, including the delicate balance of adaptable interaction versus the need for fidelity to a therapeutic model. CONCLUSIONS: This study provides further evidence that therapeutic games can support the delivery of CBT for young people in real-world settings. It also shows that deployment studies can provide a valuable means of understanding how technologies integrate with the overall mental health ecosystem and become a part of therapists' toolbox. Variability in use should be expected in real-world settings. Effective training, support for therapist autonomy, careful consideration of different approaches to customization, the reporting of deployment data, and support for communities of practice can play an important role in supporting variable, but effective, use.
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spelling pubmed-67075592019-11-18 Using Computer Games to Support Mental Health Interventions: Naturalistic Deployment Study van der Meulen, Hidde McCashin, Darragh O'Reilly, Gary Coyle, David JMIR Ment Health Original Paper BACKGROUND: Recent research has highlighted naturalistic uptake as a key barrier to maximizing the impact of mental health technologies. Although there is increasing evidence regarding the efficacy of digital interventions for mental health, as demonstrated through randomized controlled trials, there is also evidence that technologies do not succeed as expected when deployed in real-world settings. OBJECTIVE: This paper describes the naturalistic deployment of Pesky gNATs, a computer game designed to support cognitive behavioral therapy (CBT) for children experiencing anxiety or low mood. The objective of this deployment study was to identify how therapists use Pesky gNATs in real-world settings and to discover positive and negative factors. On the basis of this, we aimed to derive generalizable recommendations for the development of mental health technologies that can have greater impact in real-world settings. METHODS: Pesky gNATs has been made available through a not-for-profit organization. After 18 months of use, we collected usage and user experience data from therapists who used the game. Data were collected through an online survey and semistructured interviews addressing the expectations and experiences of both therapists and young people. Thematic analysis was used to identify key themes in the interview and survey data. RESULTS: A total of 21 therapists, who used Pesky gNATs with 95 young people, completed the online survey. Furthermore, 5 therapists participated in the follow-up interview. Confirming previous assessments, data suggest that the game can be helpful in delivering therapy and that young people generally liked the approach. Therapists shared diverse opinions regarding the young people for whom they deemed the game appropriate. The following 3 themes were identified: (1) stages of use, (2) impact on the delivery of therapy, and (3) customization. We discuss therapists’ reflections on the game with regard to their work practices and consider the question of customization, including the delicate balance of adaptable interaction versus the need for fidelity to a therapeutic model. CONCLUSIONS: This study provides further evidence that therapeutic games can support the delivery of CBT for young people in real-world settings. It also shows that deployment studies can provide a valuable means of understanding how technologies integrate with the overall mental health ecosystem and become a part of therapists' toolbox. Variability in use should be expected in real-world settings. Effective training, support for therapist autonomy, careful consideration of different approaches to customization, the reporting of deployment data, and support for communities of practice can play an important role in supporting variable, but effective, use. JMIR Publications 2019-05-09 /pmc/articles/PMC6707559/ /pubmed/31094346 http://dx.doi.org/10.2196/12430 Text en ©Hidde van der Meulen, Darragh McCashin, Gary O'Reilly, David Coyle. Originally published in JMIR Mental Health (http://mental.jmir.org), 09.05.2019. https://creativecommons.org/licenses/by/4.0/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 Mental Health, is properly cited. The complete bibliographic information, a link to the original publication on http://mental.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
van der Meulen, Hidde
McCashin, Darragh
O'Reilly, Gary
Coyle, David
Using Computer Games to Support Mental Health Interventions: Naturalistic Deployment Study
title Using Computer Games to Support Mental Health Interventions: Naturalistic Deployment Study
title_full Using Computer Games to Support Mental Health Interventions: Naturalistic Deployment Study
title_fullStr Using Computer Games to Support Mental Health Interventions: Naturalistic Deployment Study
title_full_unstemmed Using Computer Games to Support Mental Health Interventions: Naturalistic Deployment Study
title_short Using Computer Games to Support Mental Health Interventions: Naturalistic Deployment Study
title_sort using computer games to support mental health interventions: naturalistic deployment study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707559/
https://www.ncbi.nlm.nih.gov/pubmed/31094346
http://dx.doi.org/10.2196/12430
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