PHIT for Duty – A Mobile Application to Improve Psychological Health and Reduce Alcohol Use in Persons with Post-Traumatic Stress
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Abstract
Background: Psychological problems related to post traumatic stress (PTS) frequently occur after experiencing accidents, sexual assault, domestic violence, and other trauma, including combat and operational stress in military personnel. Many individuals with PTS try to cope on their own and do not avail themselves of psychological care. Our hypothesis is that such individuals may benefit from self-screening and self-help intervention (SHI), thereby preventing development of PTSD or other major disorders.
Objective: The aim is to develop and evaluate a mobile application for persons with PTS to mitigate symptoms and prevent disease, while advising those at risk to seek professional help.
Methods: PHIT for Duty integrates self-report and physiological sensor instruments to assess health status via brief weekly screening questionnaires in five domains (i.e., stress, anxiety, sleep quality, depression, and alcohol use). An expert system, called the intelligent virtual advisor (iVA), processes these data using evidence-based logic to determine health risk and to prescribe SHIs including mindfulness meditation, health education, and cognitive behavior change modules for reducing stress, attentional restructuring, improving sleep and reducing alcohol use.
Persons with high risk are advised to consult their primary care provider for a professional health assessment. Persons with mild or moderate risk (i.e., subclinical scores), are presented with a suite of interventional, therapeutic, and monitoring activities to support post-traumatic stress reduction. These include skills acquisitions (e.g., mindfulness meditation), health education (e.g., sleep hygiene), cognitive behavior change (i.e., alcohol use lessons), and self-monitoring activities (e.g., alcohol use diary). A “to-do†list of assessments and activities is updated daily and displayed on the PHIT for Duty home screen as a menu for the user.
Usability studies were conducted with 31 participants using the PHIT devices, assessments, and interventions over 10 to 28-day data collections. Self-report assessments and diaries were tested using a mix of sham and actual data including daily bedtime and wakeup sleep diaries, mindfulness-based stress reduction training with heart rate variability biofeedback, reaction time, and additional health assessments. Some participants also tested the ear pulse sensor (N=23), Zeo sleep monitor (N=27), and wrist actigraphy (N=27). Participants were debriefed on usability, technical performance, and suggestions for improvements. Usability was rated on a 1 to 5 (very hard to very easy) Likert scale, and a subset also reported on the System Usability Scale (N=9). A pilot study is underway to determine initial efficacy prior to a randomized controlled trial.
Results: Usability results are as follows (mean±sd): overall system (4.5±0.6), self-report instruments (4.5±0.7), ear pulse sensor (3.7±1.2), Zeo sleep monitor (4.4±0.7), Zeo sleep monitor comfort (3.7±1.1), and wrist actigraphy comfort (2.7±0.9). The average SUS was 85±12, indicating a high percentile rank of 95%. Results for the pilot study Research in Progress will also be presented.
Conclusions: Usability evaluation of the PHIT for Duty health assessments, physiological sensors , system acceptability, and overall system functionality have shown positive results and affirmation of the PHIT mobile application framework design. Conclusions for the pilot study Research in Progress will also be presented.
Objective: The aim is to develop and evaluate a mobile application for persons with PTS to mitigate symptoms and prevent disease, while advising those at risk to seek professional help.
Methods: PHIT for Duty integrates self-report and physiological sensor instruments to assess health status via brief weekly screening questionnaires in five domains (i.e., stress, anxiety, sleep quality, depression, and alcohol use). An expert system, called the intelligent virtual advisor (iVA), processes these data using evidence-based logic to determine health risk and to prescribe SHIs including mindfulness meditation, health education, and cognitive behavior change modules for reducing stress, attentional restructuring, improving sleep and reducing alcohol use.
Persons with high risk are advised to consult their primary care provider for a professional health assessment. Persons with mild or moderate risk (i.e., subclinical scores), are presented with a suite of interventional, therapeutic, and monitoring activities to support post-traumatic stress reduction. These include skills acquisitions (e.g., mindfulness meditation), health education (e.g., sleep hygiene), cognitive behavior change (i.e., alcohol use lessons), and self-monitoring activities (e.g., alcohol use diary). A “to-do†list of assessments and activities is updated daily and displayed on the PHIT for Duty home screen as a menu for the user.
Usability studies were conducted with 31 participants using the PHIT devices, assessments, and interventions over 10 to 28-day data collections. Self-report assessments and diaries were tested using a mix of sham and actual data including daily bedtime and wakeup sleep diaries, mindfulness-based stress reduction training with heart rate variability biofeedback, reaction time, and additional health assessments. Some participants also tested the ear pulse sensor (N=23), Zeo sleep monitor (N=27), and wrist actigraphy (N=27). Participants were debriefed on usability, technical performance, and suggestions for improvements. Usability was rated on a 1 to 5 (very hard to very easy) Likert scale, and a subset also reported on the System Usability Scale (N=9). A pilot study is underway to determine initial efficacy prior to a randomized controlled trial.
Results: Usability results are as follows (mean±sd): overall system (4.5±0.6), self-report instruments (4.5±0.7), ear pulse sensor (3.7±1.2), Zeo sleep monitor (4.4±0.7), Zeo sleep monitor comfort (3.7±1.1), and wrist actigraphy comfort (2.7±0.9). The average SUS was 85±12, indicating a high percentile rank of 95%. Results for the pilot study Research in Progress will also be presented.
Conclusions: Usability evaluation of the PHIT for Duty health assessments, physiological sensors , system acceptability, and overall system functionality have shown positive results and affirmation of the PHIT mobile application framework design. Conclusions for the pilot study Research in Progress will also be presented.
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