"The Development of an Assessment Tool to Understand Adolescents' Mental Health and the Role of Technology in Response to COVID-19" - Sarah Beary, University of Colorado- Anschutz Medical Campus

• Background: Preliminary research finds adolescents at higher risk for developing mental health problems due social isolation caused by COVID-19. Therefore, the need to identify adaptive methods for coping and maintaining well-being among adolescents is essential 1,2. The purpose of this project is to develop a high-quality assessment tool to administer during interviews with adolescents to identify technology-based solutions that adolescents can adopt to reduce mental health symptoms and enhance wellbeing. Methods: Semi-structured interviews were conducted with 10 stakeholders comprised of child development and mental health experts in order to gain knowledge on the elements of mental health and technology use that are essential for assessing adolescents’ wellbeing. The interviews covered topics on mental health and technology with focus on connection, resiliency, and compassion. Results: NVivo Qualitative Software was utilized in order to identify themes to develop the adolescent assessment tool. Findings provided direction on the structure and content of the adolescent interviews. Identified themes were: Compassion, Resiliency and Coping, Mental Health Challenges, Positive Role of Technology and Negative Role of Technology. With these findings, I created a comprehensive semi-structured adolescent interview protocol. Conclusions: Stakeholder feedback helped determine our approach in interviewing adolescents by including key topics that should be addressed among this population. This also created a standardized model for engaging with stakeholders which will help guide future research efforts. Overall, this project steered the development of a valid interview protocol which will allow us to create guidelines to facilitate beneficial technology use among adolescents.
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"Using Social Media to Address Vaccine Hesitancy and Vaccine Access During the COVID-19 Pandemic: the IMPACT Experience" - Serena Dhaon, Illinois Medical Professionals Action Collaborative Team

• Background: Although healthcare workers are trusted on social media, they often do not engage for fear of harassment and lack of time. IMPACT (Illinois Medical Professionals Action Collaborative Team) was formed at the beginning of the pandemic by physician thought leaders in Illinois to amplify HCW voices. As a result, IMPACT used crowdsourcing on social media to address both vaccine hesitancy and improve vaccine access for at-risk communities in Illinois.  Methods:  To address vaccine hesitancy, we collected data on common myths reported by healthcare workers using closed Facebook groups in Chicago and Illinois. We created 6 “debunking” infographics in both English and Spanish using climate science principles and also held Facebook lives with moms through Chicago-based Bump Club and Beyond. Leveraging groups like Chicago Vaccine Hunters, we identified vaccine access as a challenge for unaffiliated HCWs and seniors due to first-come-first-serve websites. To address these inequities, we developed clearinghouses with links to vaccine sites, tips to best schedule an appointment, and a HCW volunteer registry to staff events. By partnering with Chicago Vaccine Angels, we arranged vaccine clinics and in-home vaccination appointments throughout Illinois.  Results:  The top vaccine myths reported among HCW (n=120, primarily women) included concerns of infertility, rapid production of the vaccine, and side effects. Our COVID-19 Myth Debunkers were shared over 200 times for >80K impressions. Our more than 15 Facebook lives reached over 1000 people per session. Our clearinghouses have reached >18K people, resulting in over 1000 unaffiliated HCW obtaining vaccines. To date, we have registered >700 HCW and >1000 non-HCW volunteers for over 300 COVID-19 vaccination events in Chicago's hardest-hit communities.  Conclusion:  Healthcare professionals can strategically leverage social media to crowdsource not only potential challenges in improving vaccine hesitancy and access, but also formulate real-time solutions to facilitate equitable vaccination of their communities.
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"Patient Perspectives on Telehealth Platforms During COVID-19: A Mixed Method Study" - Ashley Huynh, UCLA Clinical and Translational Science Institute Research Associates Program (CTSI-RAP)/ University of California, Los Angeles

• COVID-19 forced healthcare systems to adapt on short notice, creating an exponential shift from traditional in-person consultations to telehealth/telemedicine. Using a large survey of 1,971 adults, we describe reported rates of telehealth services and qualitatively analyze participants’ virtual medical experiences during the pandemic. 64.2% of respondents had visits changed to telehealth over the course of the pandemic. From the responses, many described telehealth’s benefits of safety and protection (“Cancer survivor needs clinic visits...but I do not want to come to clinic during a pandemic”). However, some reported various limitations, such as lack of access (“I stopped taking my antidepressants and anti-anxiety meds [because] it is too hard to set up telehealth with a student-health psychiatrist to prescribe my refills [due to] long waiting lists”), difficulty navigating digital platforms (“For a recent visit to my rheumatologist I was unable to connect through the MyChart app, which kept crashing...After 20 minutes of no response...I was connected to her administrator who said the MD didn't know how to connect through Zoom”), and telehealth’s inability to assess the full degree of health problems (“I saw my cardiologist via telemedicine. Usually as part of the visit they listen to my heart, which cannot be done by telemedicine”). Many reported overall dissatisfaction in care, feeling that certain components of medicine could not be replicated digitally (“I typically saw about 20 doctors every three months or so...now they are all telemedicine so it feels like I’m not really getting medical help or playing my own doctor”). The abrupt transition to telehealth services has revealed limitations of currently available platforms, which led to discernible gaps in patient care. These insights can help us identify focal areas for improving digital tools and expanding the impact of telehealth services moving forward.
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"Designing for Healing: Leveraging Lived Experience in Technology-Mediated Care" - Sachin Pendse, Georgia Institute of Technology

• Background: Information and Communication Technologies (ICT) have facilitated wider spaces for people to express their mental health on their terms and access diverse forms of care, particularly those from marginalized backgrounds. However, work in digital mental health has primarily focused around treating specific symptoms of mental illness. Given the role of identity in how we understand how we are feeling, how we express how we are feeling, and the kind of care that we need and are able to receive, leveraging lived experience is paramount when designing for broader pathways to care rather than individual points of care or symptoms. With this in mind, two main questions arise --- 1) How can we leverage lived experience to design with care?, and 2) How can we design towards pathways to healing? Methods and Results: On this poster, by describing a quantitative predictive study done to understand minority use of online mental health support groups, as well as qualitative and design studies around understanding experiences with mental health helplines in India, I will analyze how care was understood by participants and how those understandings were (or were not) reflected in the design of the system. Implications: On this poster, through describing the results of my past work, I will describe recommendations for how we might design with care, towards healing, when creating technology-mediated mental health support systems, as well as other forms of digital mental health tools.
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"Design Thinking to Reduce Social Isolation in Older Adults" - Meera Shah, Tufts University

• Objective: The need for friends is universal but external changes like retirement, relocation, or death of a spouse can accentuate both the need and difficulty that older adults face in establishing new friends. Developing friendship skills and providing opportunities to practice them must be combined in a fun and enticing way to build social connections. Scientific evidence suggests this is a core psychological need and is essential to feeling satisfaction with life. Methods: In a graduate level Digital Health course at Tufts University School of Medicine, the authors used the design thinking process to develop a solution to developing friendship skills. The process included persona development, key informant interviews, and prototyping. AARP provided guidance throughout the process. Results: Live Laugh Legacy is a platform created to provide a digital intervention to enable isolated older adults to improve social skills, develop new friendships, and exchange life experiences. Live Laugh Legacy is composed of multiple projects, like making wine, gardening, and other activities, that combine learning a new skill and building social connections through guided prompts. New users complete a survey to find a project. Once enrolled, users meet at a designated location for their orientation. Participants obtain a weekly schedule, learn how to use the app, and meet others using socialization guidelines, and leave ready to work on it over the next four weeks. Each week offers socialization guidelines to utilize the app to encourage participants to connect and share progress with one another. The participants meet in person to share their accomplishments and form bonds through shared experiences. They also discuss the possibilities of forming a legacy by mentoring the incoming cohort to work on the projects. Conclusions: The changes older adults may experience in their lives may lead to social isolation. Lack of skills in developing friendships is a barrier Live Laugh Legacy addresses as part of sharing fun activities and building new skills.
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"A Data-Driven Preventive Care Platform" - Nouridine Boukari, Nytia Labs

• In Canada, three out of five people over the age of twenty live with one or more chronic diseases, four out of five are at risk, and 65% of deaths are from them. In the U.S., nearly half the population suffers from them (43%). The direct cost of chronic diseases accounts for about 58% of the annual health care spending in Canada, which is $190 billion. While the cost of diet-related disease in Canada in 2015 was estimated at $26 billion/annum. In the U.S, chronic illnesses account for 75% of the $2.2 trillion the government spends on health care each year in the U.S. The annual economic impact on the U.S. of the seven most common chronic diseases is estimated to be $1.3 trillion, which could balloon to nearly $6 trillion by 2050. Although a lot of work is being done, in the context of our platform, we’re using a data-driven approach to lower the impact of chronic diseases on both our economies and lives.
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The Role of Storage Location on Medication Adherence in the Home" - Meera Singhal, Tufts University School of Medicine

• Objective: While medication non-adherence is a well-studied problem, medication storage practices in the home is an area of research that has been understudied. The goal of this research is to explore the role of medication storage fragmentation on adherence. Methods: We developed a survey to collect data about medication management in the home and to explore use of aids to adherence. The survey was distributed via an email list from the Tufts University Osher Institute for Lifelong Learning and was posted on social media, including Twitter, Facebook, and LinkedIn. Results: A total of 1482 qualified responses were collected. On average, participants had 2.4 locations in which they stored their medications, the most common being the bedroom nightstand, kitchen cabinet, and bathroom medicine cabinet. Almost one-third (30.5%) of respondents have used non-digital ways to remember to take medications with the most common methods being pill boxes, written notes, and calendars. Further, 18.8% of respondents have stored their medications other than in the packaging it came in. While adoption of digital aids was low, with only 8.0% of respondents responding that they used an app, voice assistant, or smart pill bottle, 88.2% of respondents expressed interest in using one. Finally, younger respondents (20-29) reported a more difficult time than older respondents with maintaining a medication routine during the COVID-19 pandemic. Conclusion: Our initial investigation of medication management in the home showed that storage locations are indeed fragmented, and simple techniques are used by some to aid their adherence. Our subsequent research will look at if fragmentation of storage location contributes to poor adherence; if changing practices for obtaining medications reduce advice about both storage and adherence; and if the effectiveness of reminder aids is impacted by storage location, since many digital aids rely on visual or auditory cues. By understanding which factors lead to fragmentation of medications and how that impacts adherence, we hope to design innovative digital solutions that may promote better medication habits.
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"Predictive Models to Assess Risk of Developing Opioid Use Disorder: a Systematic Review" - Sophia Song, Brown University

• Background: This systematic review aims to consolidate evidence on the feasibility, efficacy, and accuracy of using predictive models to assess risk of opioid use disorder (OUD) in adults to inform clinical decision making. Methods: Following PRISMA guidelines, eight electronic databases were searched for studies that developed models to predict risk of opioid misuse, abuse, or overdose in adults (≥ 18 years) from inception until July 1, 2020. Study selection and data extraction were completed independently by two reviewers. Risk of bias was assessed independently by two reviewers using the PROBAST tool for predictive model studies. Results: 22 studies met inclusion criteria; study types included retrospective cohort (11), prospective cohort (7), observational (3), and case-control (1). Models included logistic regression (9), multiple models (6), random forest (1), LASSO regression (2), neural network (1), Poisson (1), proportional hazards (1), and support vector machine (1). Primary outcomes included opioid use disorder (8), opioid overdose (6), persistent opioid use (5), fatal opioid overdose (2), and opioid-induced-respiratory depression (1). Models were developed from databases (9), electronic health records (7), insurance claims (2), patient-reported data (2), prescription drug monitoring programs (1), and multiple sources (1). Area under the receiver operating curve ranged from 0.692 to 0.951, sensitivity ranged from 0.707 to 0.972, and specificity ranged from 0.135 to 0.99; other accuracy metrics reported included the Akaike information criterion (18,582.9 to 25,763.8) and Euclidean loss (39.2939). The most common predictor variables were age, sex, history of mental illness, and history of substance use disorder. Only one study deployed a model in real-time. Conclusion: While many studies examine associations between risk factors for OUD, few studies develop predictive models. It is feasible to develop models to assess risk of OUD with high accuracy; however, few models are implemented in real-time practice to inform clinician decision making.
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"StayWell at Home: A Text Messaging Intervention to Counteract Depression and Anxiety during COVID-19 Social Distancing" - Alein Haro, UC Berkeley

• Background: Social distancing and stay-at-home orders are critical interventions to slow down person-to-person transmission of COVID-19. While these societal changes help to contain the pandemic, they also have unintended negative consequences, including anxiety and depression. We developed StayWell, a daily skills-based SMS text messaging program, to mitigate COVID-19 related depression and anxiety symptoms among people who speak English and Spanish in the United States. Objective: This paper describes the changes in the anxiety and depression levels of participants in the StayWell program after 60 days of exposure to skills-based SMS text messages. Methods: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of StayWell participants. Anxiety and depression were measured using the 2-item Generalized Anxiety Disorder (GAD-2) scale and the 8-item Patient Health Questionnaire (PHQ-8) scale at baseline and 60-day timepoints. We used paired t-tests to detect the change in PHQ-8 and GAD-2 scores from baseline to follow-up measured 60 days later. Results: The analytic sample includes 193 participants who completed both the baseline and 60-day exit questionnaires. At the 60-day time point, there were statistically significant reductions in both PHQ-8 and GAD-2 scores from baseline. We found an average reduction of -1.72 (95% CI: -2.35, -1.09) in PHQ-8 scores and -0.48 (95% CI: -0.71, -0.25) in GAD-2 scores. This translated to an 18.5% and 17.2% reduction in mean PHQ-8 scores and GAD-2, respectively. Conclusions: StayWell is a low-intensity, cost-effective, and accessible population-level mental health intervention. Participation in StayWell focused on COVID-19 mental health coping skills and was related to improved depression and anxiety symptoms. In addition to improvements in outcomes, we found high levels of engagement during the 60-day intervention period. Text messaging interventions could serve as an important public health tool for disseminating strategies to manage mental health.
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"Digital Health Intervention to Promote Engagement in and Adherence to Medication for Opioid Use Disorder Treatment – Findings from an Open Pilot Trial" - Paola Jiménez Muñoz, Brown-Lifespan Center for Digital Health

• Background: While buprenorphine-naloxone (BUP) is an evidence-based approach to treating Opioid Use Disorder, a significant portion of patients discontinue treatment or return to illicit opioid use. Novel intervention strategies that may be delivered outside of traditional treatment settings are needed to support BUP uptake and maintenance. The goal of this study was to conduct an open pilot trial to elucidate acceptability/feasibility of an interactive computer- and text message-delivered personalized feedback intervention for adults initiating outpatient BUP treatment. Methods: Patients (n=9), who initiated BUP within the past 8 weeks, were recruited to participate. Following informed consent procedures and baseline assessments, participants completed a computer intervention focused on enhancing motivation and providing psychoeducation on distress tolerance skills. Afterwards and over the following 8 weeks, participants received daily messages that 1) provided a reminder of salient motivational factors, and 2) recommended a coping skill personalized to the participant’s assessment of mood and urges. Participants completed measures of intervention satisfaction and perceived usability following the computer intervention and at the end of the 8-week period. Additional perspectives were captured via qualitative exit interviews. Results: Recruitment and participation is ongoing. To date, 80% of participants engaged with the text messages throughout the entire 8-week period. The mean score on the Client Satisfaction Questionnaire (CSQ-8) was 22.375 following the computer intervention and 22 at the end of the text message program, indicating a high degree of satisfaction with the intervention. The average rating on the System Usability Scale (SUS) at the end of the 8-week program was 60.63%, suggesting that the intervention was relatively easy to use. Consistent with self-report ratings about feasibility and usability, participants endorsed positive experiences with the intervention. Conclusions: Preliminary findings of this open pilot trial suggest that iCOPE is perceived as an acceptable intervention to augment outpatient buprenorphine treatment. Future work will evaluate the efficacy of iCOPE in a randomized clinical trial.
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"Exploring The Discussion Of Nexplanon (Etonogestrel Birth Control Implant) On Twitter" - Lekha Pillarisetti, Social Media and Adolescent Health Research Team (SMAHRT)/University of Wisconsin, Madison

• The Federal Drug Administration (FDA) has approved medical birth control implants associated with over 100,000 stillbirths. Few studies have examined tools to assess the risk of federally approved medical devices already on the market, such as social media. This study examined Twitter content discussing the medical birth control implant, Nexplanon, including changes in displays over time. In this content analysis study, public Tweets from #Nexplanon were collected using Top and Latest searches. Tweets were evaluated for dates, reported symptoms and positive/negative attitude. The Linguistic Inquiry and Word Count (LIWC) was used to assess Tweets for the variables: positive and negative affect, anxiety, anger and sadness. Descriptive statistics assessed the frequency of reported symptoms and positive/negative attitude. A T-test and χ2 test assessed the positive/negative attitude Tweets and LIWC variables between Top and Latest searches as well as negative/positive attitude and time. Of all Tweets (n=91), 41 were identified using the Top search and 50 via the Latest search. Of Tweets referencing reported symptoms (40.6%, n=37), 22% indicated issues with the implantation site (upper arm), 32% indicated issues with lengthened/excessive bleeding period, 24% indicated mental health problems and 27% indicated other side effects. Tweets from the Top search were more likely to report a positive attitude (63.4%) than those from the Latest search (27.9%, χ2 = 9.6888, p = .001). There were no significant differences in LIWC variables between Top and Latest searches. There was a positive association between the number of Tweets showing negative (p = .024) and positive attitude (p = .026) and time in years. Of the Tweets collected, 40.6% reported symptoms associated with Nexplanon which may be of concern. Tweets from the Latest search were almost twice as likely to display positive attitude than negative, which could indicate a recent spike in negative attitude towards Nexplanon.
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"Preliminary Findings of a Content Analysis of the Viral Hashtag #HowIFightDepression" - Matthew Schroeder, University of Connecticut

• Background: People have taken to social media to discuss mental health issues. On June 19, 2019, the hashtag #HowIFightDepression was trending on Twitter as one of the most popularly discussed hashtags of the moment. The present study aimed to content analyze the tweets to determine how people discuss their depression coping behaviors. Methods: Tweets with the hashtag were pulled from June 19-23, 2019. After retweets were excluded, 9616 eligible tweets remained. A total of 1359 tweets were randomly selected for coding. Tweets (n=338) were excluded if they were in a foreign language or cryptic. Two raters coded 1021 (κ=.805). Frequencies of each coping strategy were calculated. Results: A total of 16 coping strategies were identified, 11 of which were potentially helpful and 5 were potentially harmful. Of the 1021 tweets, potentially helpful coping strategies included keeping a positive attitude (n = 342, 34%), social support seeking (n = 270, 26%), hobby (n = 173, 17%), evidence-based depression treatment (n = 151, 15%), being productive (n = 147, 14%), mindfulness (n = 130, 13%), exercise (n = 118, 12%), pets/animals (n = 84, 8%), spiritual activities (n = 84, 8%), and humor (n = 47, 5%). Potentially harmful coping strategies included screentime (n = 131, 13%), eating (n = 78, 8%), sleep (n = 55, 5%), taking recreational drugs (n = 39, 4%), and using vitamins, supplements, and oils (n = 15, 1%). Conclusion: Results showed the most common coping strategy mentioned involved keeping a positive attitude (e.g., sharing uplifting messages), but only 15% of tweets mentioned evidence-based depression treatments. Given the reach of viral hashtags, social media may be a way to facilitate positive, destigmatizing conversations about depression. Further research should explore how social media can be used as a platform to generate peer support for mental health problems.
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