Irvine, Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA.
Department of Psychiatry and Behavioral Sciences, Section of Community Behavioral Health, Rush University, Chicago, Illinois, USA.
J Child Adolesc Psychiatr Nurs. 2023 Feb;36(1):7-16. doi: 10.1111/jcap.12396. Epub 2022 Sep 22.
Mobile Health (mHealth) stands as a potential means to better reach, assess, and intervene with teens with socially complex needs. These youth often face overlapping adversities including medical illness and a history of experiencing adverse childhood experiences (ACEs). Clinicians are faced with navigating ethical decisions when developing mHealth tools for teens who have socially complex needs. Many tools have been developed for adults from the general population. However, despite the development of thousands of mHealth interventions, developers tend to focus on designing for usability, engagement, and efficacy, with less attention on the ethical considerations of making such tools.
To safely move mHealth interventions from research into clinical practice, ethical standards must be met during the design phase. In this paper we adapt the Four Box Model (i.e., medical indications, preferences of patients, quality of life, and contextual features) to guide mHealth developers through ethical considerations when designing mHealth interventions for teens who present with a medical diagnosis and a history of ACEs.
A review of language, inclusive features, data sharing, and usability is presented using both the Four Box Model and potential scenarios to guide each consideration.
To better support designers of mHealth tools we present a framework for evaluating applications to determine overlap with ethical design and are well suited for use in clinical practice with underserved pediatric patients.
移动健康(mHealth)是一种潜在的手段,可以更好地接触、评估和干预具有社会复杂需求的青少年。这些年轻人常常面临着多种逆境,包括疾病和经历过不良童年经历(ACEs)的历史。临床医生在为具有社会复杂需求的青少年开发 mHealth 工具时,面临着做出伦理决策的挑战。许多工具是为一般人群中的成年人开发的。然而,尽管已经开发了数千种 mHealth 干预措施,但开发人员往往更注重设计可用性、参与度和疗效,而对制作此类工具的伦理考虑关注较少。
为了安全地将 mHealth 干预措施从研究转移到临床实践中,在设计阶段必须符合伦理标准。在本文中,我们采用四框模型(即医疗适应症、患者偏好、生活质量和环境特征)来指导 mHealth 开发人员在为患有医疗诊断和 ACEs 病史的青少年设计 mHealth 干预措施时考虑伦理问题。
使用四框模型和潜在场景对语言、包容性特征、数据共享和可用性进行了审查,以指导每个方面的考虑。
为了更好地支持 mHealth 工具的设计者,我们提出了一个评估应用程序的框架,以确定与伦理设计的重叠,并非常适合在临床实践中用于服务不足的儿科患者。