Zelmer Jennifer, van Hoof Krystle, Notarianni MaryAnn, van Mierlo Trevor, Schellenberg Megan, Tannenbaum Cara
Azimuth Health Group & University of Victoria, Toronto, ON, Canada.
Canadian Institutes of Health Research, Institute of Gender and Health, Montreal, QC, Canada.
JMIR Mhealth Uhealth. 2018 Jul 9;6(7):e10016. doi: 10.2196/10016.
The number of e-mental health apps is increasing rapidly. Studies have shown that the use of some apps is beneficial, whereas others are ineffective or do not meet users' privacy expectations. Individuals and organizations that curate, recommend, host, use, or pay for apps have an interest in categorizing apps according to the consensus criteria of usability and effectiveness. Others have previously published recommendations for assessing health-related apps; however, the extent to which these recommendations can be generalized across different population groups (eg, culture, gender, and language) remains unclear. This study describes an attempt by Canadian stakeholders to develop an e-mental health assessment framework that responds to the unique needs of people living in Canada in an evidence-based manner.
The objective of our study was to achieve consensus from a broad group of Canadian stakeholders on guiding principles and criteria for a framework to assess e-mental health apps in Canada.
We developed an initial set of guiding principles and criteria from a rapid review and environmental scan of pre-existing app assessment frameworks. The initial list was refined through a two-round modified Delphi process. Participants (N=25) included app developers and users, health care providers, mental health advocates, people with lived experience of a mental health problem or mental illness, policy makers, and researchers. Consensus on each guideline or criterion was defined a priori as at least 70% agreement. The first round of voting was conducted electronically. Prior to Round 2 voting, in-person presentations from experts and a persona empathy mapping process were used to explore the perspectives of diverse stakeholders.
Of all respondents, 68% (17/25) in Round 1 and 100% (13/13) in Round 2 agreed that a framework for evaluating health apps is needed to help Canadian consumers identify high-quality apps. Consensus was reached on 9 guiding principles: evidence based, gender responsive, culturally appropriate, user centered, risk based, internationally aligned, enabling innovation, transparent and fair, and based on ethical norms. In addition, 15 informative and evaluative criteria were defined to assess the effectiveness, functionality, clinical applicability, interoperability, usability, transparency regarding security and privacy, security or privacy standards, supported platforms, targeted users, developers' transparency, funding transparency, price, user desirability, user inclusion, and meaningful inclusion of a diverse range of communities.
Canadian mental health stakeholders reached the consensus on a framework of 9 guiding principles and 15 criteria important in assessing e-mental health apps. What differentiates the Canadian framework from other scales is explicit attention to user inclusion at all stages of the development, gender responsiveness, and cultural appropriateness. Furthermore, an empathy mapping process markedly influenced the development of the framework. This framework may be used to inform future mental health policies and programs.
电子心理健康应用程序的数量正在迅速增加。研究表明，使用某些应用程序是有益的，而其他应用程序则无效或不符合用户的隐私期望。策划、推荐、托管、使用或为应用程序付费的个人和组织有兴趣根据可用性和有效性的共识标准对应用程序进行分类。其他人此前已发布评估健康相关应用程序的建议；然而，这些建议在不同人群（如文化、性别和语言）中能够普遍适用的程度仍不明确。本研究描述了加拿大利益相关者试图以循证的方式制定一个能满足加拿大居民独特需求的电子心理健康评估框架。
我们研究的目的是让广大加拿大利益相关者就评估加拿大电子心理健康应用程序框架的指导原则和标准达成共识。
我们通过对现有应用程序评估框架的快速回顾和环境扫描，制定了一套初步的指导原则和标准。通过两轮改进的德尔菲法对初始列表进行了完善。参与者（N = 25）包括应用程序开发者和用户、医疗保健提供者、心理健康倡导者、有心理健康问题或精神疾病亲身经历的人、政策制定者和研究人员。每条指南或标准的共识事先定义为至少70%的同意率。第一轮投票通过电子方式进行。在第二轮投票之前，专家进行了现场演示，并采用了角色共情映射过程来探索不同利益相关者的观点。
在所有受访者中，第一轮有68%（17/25），第二轮有100%（13/13）同意需要一个评估健康应用程序的框架来帮助加拿大消费者识别高质量的应用程序。就9条指导原则达成了共识：循证、性别敏感、文化适宜、以用户为中心、基于风险、国际接轨、促进创新、透明公平以及基于道德规范。此外，还定义了15条信息性和评估性标准，以评估有效性、功能、临床适用性、互操作性、可用性、安全和隐私方面的透明度、安全或隐私标准、支持的平台、目标用户、开发者的透明度、资金透明度、价格、用户吸引力、用户包容性以及不同社区的有意义包容性。
加拿大心理健康利益相关者就评估电子心理健康应用程序的9条指导原则和15条标准的框架达成了共识。加拿大框架与其他量表的不同之处在于，在开发的各个阶段都明确关注用户包容性、性别敏感性和文化适宜性。此外，共情映射过程对框架的制定产生了显著影响。该框架可用于为未来的心理健康政策和项目提供参考。
