OVERVIEW

BACKGROUND

Wearable health sensing technology can enable patients and health care providers to make more informed decisions. However, studies on the use of werables in the clinic have primarily focused on physical health — we have little understanding of the role that data from wearables can play in mental health. We wanted to find out:

How do mental health care providers envision using sensor data FROM WEARABLES in treatment?

RESEARCH SITE

Rush Road Home Center for Veterans & Their Families offers an Intensive Treatment Program (ITP): a three-week program that provides veterans individualized care for trauma-based disorders and injury. As a part of the program, each client receives a complementary wrist-worn physical activity tracker — a Fitbit. However, data from the Fitbit were not being incorporated into the care process. This was the perfect opportunity to conduct research.

RESEARCH OBJECTIVES

• Explore opportunities where sensor data can be utilized to improve client care

• Identify barriers that prevent use of data by exploring the needs, interests, and requirements of clients, clinicians, and the administrative team at the Rush Road Home program

PROCESS

PARTICIPANTS

In order to get a well-rounded perspective on the opportunities and limitations to engaging with Fitbit data, I interviewed veterans, clinical team members, and administrators of the Road Home Program

PROCEDURE

• 1-hour individual interviews with thirteen veterans, fourteen clinical team members, and three administrators

  • Veterans were asked about their prior experiences tracking as well as any use of their Fitbit and its data during and after treatment

  • Clinical team members were asked about their prior experiences with patient-generated data as well as any use of their Fitbit during and after treatment

  • Administraters were asked about their prior experiences with patient-generated data and their envisioned uses for the Fitbits

• Qualitative analysis of transcripts

FINDINGS

• Not surprisingly, while the use of the Fitbits was not formally incorporated into the therapy process, veterans used the device to monitor their own physical activity and sleep disturbance (both of which are related to PTSD symptomology). The data served as a tool to foster social connection between clients during treatment.

• Given the uncertainty around the validity of data and more specifically, the lack of evidence-based treatment protocols when it comes to the use of sensor data in therapy, clinical team members were wary of using the data. Research connecting data from wearables to traditional measures of mental health (e.g. PHQ-9 and PCL-5 self-report questionnaires) are necessary before devices can be trusted.

• An often discussed benefit of sensor-captured data are the ‘objective’ reflection of behaviors. However, when it comes to mental health, these objective measures must still be situated among the patient’s subjective context in order to be interpretable and useful in treatment.
  

IMPACT

As a result of this work, my research collaborators and I were invited to a workshop hosted by Reos Partners and funded by the Robert Wood Johnson Foundation exploring opportunities to integrate passively captured health data into clinical care. Alongside leadership at the Road Home Program, we road-mapped various use cases for data from Fitbits and proposed integration plans.

The result was the development of a multi-phase integration plan: on-boarding a small subset of clinical power users for a pilot test of the proposed uses for wearable data to assess effectiveness as measured through traditional clinical surveys in order to determine whether to fully integrate Fitbits into care. See more information at Collaborative Healthcare Using Patient-Generated Data.

PUBLICATIONS

• Ng, A., Kornfield, R., Schueller, S. M., Zalta, A. K., Brennan, M., & Reddy, M. (2019). Provider Perspectives on Integrating Sensor-Captured Patient-Generated Data in Mental Health Care. Proceedings of the ACM on Human-Computer Interaction, Vol.3 (CSCW).

  • PRESENTATION AT CSCW 2019 in AUSTIN, TX
    PDF version here.

• Ng, A., Reddy, M., Zalta, A. K., & Schueller, S. M. (2018). Veterans’ Perspectives on Fitbit Use in Treatment for Post-Traumatic Stress Disorder: An Interview Study. JMIR mental health, 5(2), e10415.