Yeager Carolyn M, Benight Charles C
Psychology Department, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA.
Trauma, Health, & Hazards Center, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA.
Mhealth. 2018 Sep 11;4:37. doi: 10.21037/mhealth.2018.08.04. eCollection 2018.
Exposure to traumatic events is extremely common with nearly 75% reported to have experienced one or more traumatic events worldwide. A significant number of those exposed will develop posttraumatic stress disorder (PTSD) along with depression, anxiety, and substance use disorders. Globally, trauma-related mental health disorders are the leading cause of global disability burden, and many of these disorders are caused, or worsened, by exposure to wars, natural and human-caused disasters, and other traumatic events. Significant barriers to treatment exist including logistical, geographical, financial, stigma, and other attitudinal challenges. One opportune approach to overcoming these barriers is the provision of mental health interventions via technology that can be readily standardized for wide dissemination of evidence-based care. However, engagement with technology-based interventions is a concern and limited participation and high attrition rates are common. This may be especially true for trauma survivors who often experience symptoms of avoidance and hyperarousal. Engagement is regarded as an essential component of intervention efficacy and has been demonstrated to be associated with more positive clinical outcomes, yet theoretically based research in this area is sparse. This review focuses on the complex issue of engagement with digital health interventions (DHIs). Specifically, we review the conceptualization and measurement of engagement, predictors of engagement, and importantly, the relationship of engagement with intervention effectiveness. Finally, a theoretically based model of engagement is proposed that considers the unique challenges of trauma recovery. This review is not intended to provide a systematic or exhaustive set of recommendations, rather it is intended to highlight the challenges of engagement research including its definition, measurement, and modeling. Future engagement research that includes valid and reliable measures of engagement will enable consistent exploration of engagement predictors that can then inform methods for increasing engagement and, ultimately, intervention effectiveness.
遭受创伤性事件极为常见，据报道，全球近75%的人经历过一次或多次创伤性事件。其中相当一部分人会患上创伤后应激障碍（PTSD），同时还伴有抑郁症、焦虑症和物质使用障碍。在全球范围内，与创伤相关的心理健康障碍是全球残疾负担的主要原因，而且这些障碍中的许多是由战争、自然和人为灾害以及其他创伤性事件导致或加剧的。治疗存在重大障碍，包括后勤、地理、财务、耻辱感以及其他态度方面的挑战。克服这些障碍的一种合适方法是通过技术提供心理健康干预措施，这些措施可以很容易地标准化，以便广泛传播循证护理。然而，参与基于技术的干预措施是一个令人担忧的问题，参与度有限和高流失率很常见。对于经常经历回避和过度警觉症状的创伤幸存者来说，情况可能尤其如此。参与被视为干预效果的一个重要组成部分，并且已被证明与更积极的临床结果相关，但该领域基于理论的研究很少。本综述重点关注与数字健康干预措施（DHI）相关的复杂参与问题。具体而言，我们回顾了参与的概念化和测量、参与的预测因素，重要的是，参与与干预效果的关系。最后，提出了一个基于理论的参与模型，该模型考虑了创伤恢复的独特挑战。本综述并非旨在提供一套系统或详尽的建议，而是旨在突出参与研究的挑战，包括其定义、测量和建模。未来的参与研究如果包括有效且可靠的参与度测量方法，将能够持续探索参与度预测因素，进而为提高参与度以及最终提高干预效果的方法提供信息。
