Department of Psychiatry and Neuropychology, School for Mental Health and Neuroscience, Maastricht University, Vijverdalseweg 1, Maastricht, 6226 NB, the Netherlands.
Mondriaan Mental Health Center, Heerlen, The Netherlands.
BMC Public Health. 2024 Jun 19;24(1):1633. doi: 10.1186/s12889-024-19143-z.
Technology improves accessibility of psychological interventions for youth. An ecological momentary intervention (EMI) is a digital intervention geared toward intervening in daily life to enhance the generalizability and ecological validity, and to be able to intervene in moments most needed. Identifying working mechanisms of the use of ecological momentary interventions might generate insights to improve interventions.
The present study investigates the working mechanisms of the use and acceptability of an ecological momentary intervention, named SELFIE, targeting self-esteem in youth exposed to childhood trauma, and evaluates under what circumstances these mechanisms of use and acceptability do or do not come into play. A realist evaluation approach was used for developing initial program theories (data: expert interviews and a stakeholders focus group), and subsequently testing (data: 15 interviews with participants, a focus group with therapists, debriefing questionnaire), and refining them.
The SELFIE intervention is offered through a smartphone application enabling constant availability of the intervention and thereby increasing accessibility and feasibility. When the intervention was offered on their personal smartphone, this enhanced a sense of privacy and less hesitance in engaging with the app, leading to increased disclosure and active participation. Further, the smartphone application facilitates the practice of skills in daily life, supporting the repeated practice of exercises in different situations leading to the generalizability of the effect. Buffering against technical malfunction seemed important to decrease its possible negative effects.
This study enhanced our understanding of possible working mechanisms in EMIs, such as the constant availability supporting increased accessibility and feasibility, for which the use of the personal smartphone was experienced as a facilitating context. Hereby, the current study contributes to relatively limited research in this field. For the field to move forward, mechanisms of use, and acceptability of EMIs need to be understood. It is strongly recommended that alongside efficacy trials of an EMI on specific target mechanisms, a process evaluation is conducted investigating the working mechanisms of use.
The current paper reports on a realist evaluation within the SELFIE trial (Netherlands Trial Register NL7129 (NTR7475)).
技术提高了青少年接受心理干预的便利性。生态瞬时干预（EMI）是一种数字干预措施，旨在干预日常生活，以提高普遍性和生态有效性，并能够在最需要的时刻进行干预。确定生态瞬时干预使用的工作机制可能会为改进干预措施提供启示。
本研究调查了针对儿童期创伤后自尊心的生态瞬时干预措施 SELFIE 的使用和可接受性的工作机制，并评估了在何种情况下这些使用和可接受性机制发挥作用或不起作用。采用现实评估方法来开发初始方案理论（数据：专家访谈和利益相关者焦点小组），随后进行测试（数据：15 名参与者访谈、治疗师焦点小组、汇报问卷）并对其进行改进。
SELFIE 干预措施通过智能手机应用程序提供，使干预措施随时可用，从而提高了可及性和可行性。当将干预措施提供给他们个人的智能手机时，这增强了隐私感，减少了对应用程序的犹豫，从而提高了披露率和积极参与度。此外，智能手机应用程序促进了日常生活中技能的实践，支持在不同情况下重复练习，从而使效果具有普遍性。缓解技术故障似乎很重要，可以降低其可能的负面影响。
本研究增进了我们对 EMI 中可能的工作机制的理解，例如，支持增加可及性和可行性的随时可用性，个人智能手机的使用被体验为一个促进性的环境。因此，本研究为该领域相对有限的研究做出了贡献。为了使该领域取得进展，需要了解 EMI 的使用和可接受性的机制。强烈建议在对特定目标机制的 EMI 进行疗效试验的同时，进行过程评估，以调查使用的工作机制。
本论文报告了 SELFIE 试验中的一项现实评估（荷兰试验注册 NL7129（NTR7475））。
