Enhancing Therapeutic Processes in Videoconferencing Psychotherapy: Interview Study of Psychologists' Technological Perspective.

BACKGROUND: The COVID-19 pandemic caused a surge in the use of telehealth platforms. Psychologists have shifted from face-to-face sessions to videoconference sessions. Therefore, essential information that is easily obtainable via in-person sessions may be missing. Consequently, therapeutic work could be compromised. OBJECTIVE: This study aimed to explore the videoconference psychotherapy (VCP) experiences of psychologists around the world. Furthermore, we aimed to identify technological features that may enhance psychologists' therapeutic work through augmented VCP. METHODS: In total, 17 psychologists across the world (n=7, 41% from Australia; n=1, 6% from England; n=5, 29% from Italy; n=1, 6% from Mexico; n=1, 6% from Spain; and n=2, 12% from the United States) were interviewed. We used thematic analysis to examine the data collected from a sample of 17 psychologists. We applied the Chaos Theory to interpret the system dynamics and collected details about the challenges posed by VCP. For collecting further information about the technology and processes involved, we relied on the Input-Process-Output (IPO) model. RESULTS: The analysis resulted in the generation of 9 themes (input themes: psychologists' attitude, trust-reinforcing features, reducing cognitive load, enhancing emotional communication, and engaging features between psychologists and patients; process themes: building and reinforcing trust, decreasing cognitive load, enhancing emotional communication, and increasing psychologist-patient engagement) and 19 subthemes. Psychologists found new strategies to deal with VCP limitations but also reported the need for more technical control to facilitate therapeutic processes. The suggested technologies (eye contact functionality, emergency call functionality, screen control functionality, interactive interface with other apps and software, and zooming in and out functionality) could enhance the presence and dynamic nature of the therapeutic relationship. CONCLUSIONS: Psychologists expressed a desire for enhanced control of VCP sessions. Psychologists reported a decreased sense of control within the therapeutic relationship owing to the influence of the VCP system. Great control of the VCP system could better approximate the critical elements of in-person psychotherapy (eg, observation of body language). To facilitate improved control, psychologists would like technology to implement features such as improved eye contact, better screen control, emergency call functionality, ability to zoom in and out, and an interactive interface to communicate with other apps. These results contribute to the general perception of the computer as an actual part of the VCP process. Thus, the computer plays a key role in the communication, rather than remaining as a technical medium. By adopting the IPO model in the VCP environment (VCP-IPO model), the relationship experience may help psychologists have more control in their VCP sessions.

Technology for societal change: Evaluating a mobile app addressing the emotional needs of people experiencing homelessness.

New technology that aims to tackle the systemic and societal problems face challenges bringing together diverse stakeholder perspectives effectively. We evaluate how an emotion-led approach, with a Living Lab process may be effective in these situations. We discuss findings and their implications for this in the context of the development and ongoing maintenance of a web app called "Ask Izzy". Ask Izzy supports people who are homeless or are otherwise disadvantaged by providing information and consequently improving their everyday life and wellbeing. We present a mixed-method evaluation of the web app: firstly, we evaluate impact of key design decisions upon engagement. Secondly, we conducted semi-structured interviews with 30 participants who are either homeless, ex-homeless or service providers and used content analysis. Then we demonstrate that our emotion-led approach brings a novel perspective on concerns from key actors influencing the refinement of the app. The results section outlines emotional goals such as a feeling of control that were important to consider in order to meet the needs of both end users and the wider service provision network. Our study provides recommendations and an approach that may inform others in developing and delivering similar health care and related systems and services.

BYOD usage and security behaviour of hospital clinical staff: An Australian survey.

OBJECTIVE: Healthcare professionals are known to use their personal devices extensively for work purposes (Bring-Your-Own-Device). However, it is also a source of major concern for healthcare organisations, given the heavy reliance of patient data privacy on clinician's usage behaviour and higher risk of data breaches. Previous research into hospital BYOD security has been scarce and fragmented. Therefore, the aim of this paper is to understand the preferences, behaviour, and knowledge of Australian hospital clinical staff with respect to BYOD security through a survey. METHOD: An online survey was conducted among clinicians working in Australian hospitals, asking them about their BYOD related user behaviour, knowledge of best practices, and support received from their hospitals. Descriptive statistical analysis and cross tabulation were carried out on the survey data. RESULTS: Majority of the surveyed clinicians used BYOD (87%). Some of the good behavioural practices found included use of passcode: (91.95%), never disclosing password (67.82%); strong passwords (63.22%) and no storage of patient data (59.77%) on BYOD devices. However, several risky practices were also found, particularly when usability or clinical workflow mattered to clinicians including use of personal/social apps for clinical communication (e.g. SMS: 57.47%, WhatsApp: 39.08%); connecting BYOD devices containing patient data to public hotspots (40.23%) and use of a common data backup platform for personal and patient data (79.93%). A large proportion of surveyed clinicians were either unaware or didn't receive BYOD related security training (74.71%) or policy (39.08%), but those who did were more confident across all aspects of BYOD security asked in the survey, indicating their importance. CONCLUSION: By taking a wholistic and socio-technical view, this study helps us to better understand BYOD related security behaviour of hospital-based clinicians and its consequential implications. It can therefore provide important insights for both technical and clinical stakeholders of BYOD within hospitals.

A Perspective on Client-Psychologist Relationships in Videoconferencing Psychotherapy: Literature Review.

BACKGROUND: During the COVID-19 pandemic, people have been encouraged to maintain social distance. Technology helps people schedule meetings as remote videoconferencing sessions rather than face-to-face interactions. Psychologists are in high demand because of an increase in stress as a result of COVID-19, and videoconferencing provides an opportunity for mental health clinicians to treat current and new referrals. However, shifting treatment from face-to-face to videoconferencing is not simple: both psychologists and clients miss in-person information cues, including body language. OBJECTIVE: This review proposes a new theoretical framework to guide the design of future studies examining the impact of a computer as a mediator of psychologist-client relationships and the influence of videoconferencing on the relationship process. METHODS: We conducted a literature review including studies focused on communication and key concepts of the therapeutic relationship and therapeutic alliance. RESULTS: Studies have reported that clients are generally satisfied with videoconference therapy in terms of the relationship with their therapists and the establishment of the therapeutic alliance. Conversely, studies indicate that psychologists continue to highlight difficulties in establishing the same quality of therapeutic relationship and therapeutic alliance. The contrasting experiences might underlie the differences in the type of emotional and cognitive work required by both actors in any therapy session; furthermore, the computer seems to take part in their interaction not only as a vehicle to transmit messages but also as an active part of the communication. A new model of interaction and relationship is proposed, taking into account the presence of the computer, along with further hypotheses. CONCLUSIONS: It is important to consider the computer as having an active role in the client-psychologist relationship; thus, it is a third party to the communication that either assists or interferes with the interaction between psychologists and clients.

From way across the sea: Information overload and international students during the COVID-19 pandemic.

This panel examines the interaction between being a transient migrant, using international students as a salient example, and information behaviors in a time of COVID-19. We address issues such as information overload, selection of information sources, and social networking. The aim of this panel is to bring together interested researchers in the areas of information practices, higher education, and intercultural communication.

Hospital Bring-Your-Own-Device Security Challenges and Solutions: Systematic Review of Gray Literature.

BACKGROUND: As familiarity with and convenience of using personal devices in hospitals help improve the productivity, efficiency, and workflow of hospital staff, the health care bring-your-own-device (BYOD) market is growing consistently. However, security concerns owing to the lack of control over the personal mobile devices of staff, which may contain sensitive data such as personal health information of patients, make it one of the biggest health care information technology (IT) challenges for hospital administrations. OBJECTIVE: Given that the hospital BYOD security has not been adequately addressed in peer-reviewed literature, the aim of this paper was to identify key security challenges associated with hospital BYOD usage as well as relevant solutions that can cater to the identified issues by reviewing gray literature. Therefore, this research will provide additional practical insights from current BYOD practices. METHODS: A comprehensive gray literature review was conducted, which followed the stepwise guidelines and quality assessment criteria set out by Garousi et al. The searched literature included tier 1 sources such as health care cybersecurity market reports, white papers, guidelines, policies, and frameworks as well as tier 2 sources such as credible and reputed health IT magazines, databases, and news articles. Moreover, a deductive thematic analysis was conducted to organize the findings based on Schlarman's People Policy Technology model, promoting a holistic understanding of hospitals' BYOD security issues and solutions. RESULTS: A total of 51 sources were found to match the designed eligibility criteria. From these studies, several sociotechnical issues were identified. The major challenges identified were the use of devices with insufficient security controls by hospital staff, lack of control or visibility for the management to maintain security requirements, lack of awareness among hospital staff, lack of direction or guidance for BYOD usage, poor user experience, maintenance of legal requirements, shortage of cybersecurity skills, and loss of devices. Although technologies such as mobile device management, unified endpoint management, containerization, and virtual private network allow better BYOD security management in hospitals, policies and people management measures such as strong security culture and staff awareness and training improve staff commitment in protecting hospital data. CONCLUSIONS: The findings suggest that to optimize BYOD security management in hospitals, all 3 dimensions of the security process (people, policy, and technology) need to be given equal emphasis. As the nature of cybersecurity attacks is becoming more complex, all dimensions should work in close alignment with each other. This means that with the modernization of BYOD technology, BYOD strategy, governance, education, and relevant policies and procedures also need to adapt accordingly.

Development of a Mobile Clinical Prediction Tool to Estimate Future Depression Severity and Guide Treatment in Primary Care: User-Centered Design.

BACKGROUND: Around the world, depression is both under- and overtreated. The diamond clinical prediction tool was developed to assist with appropriate treatment allocation by estimating the 3-month prognosis among people with current depressive symptoms. Delivering clinical prediction tools in a way that will enhance their uptake in routine clinical practice remains challenging; however, mobile apps show promise in this respect. To increase the likelihood that an app-delivered clinical prediction tool can be successfully incorporated into clinical practice, it is important to involve end users in the app design process. OBJECTIVE: The aim of the study was to maximize patient engagement in an app designed to improve treatment allocation for depression. METHODS: An iterative, user-centered design process was employed. Qualitative data were collected via 2 focus groups with a community sample (n=17) and 7 semistructured interviews with people with depressive symptoms. The results of the focus groups and interviews were used by the computer engineering team to modify subsequent protoypes of the app. RESULTS: Iterative development resulted in 3 prototypes and a final app. The areas requiring the most substantial changes following end-user input were related to the iconography used and the way that feedback was provided. In particular, communicating risk of future depressive symptoms proved difficult; these messages were consistently misinterpreted and negatively viewed and were ultimately removed. All participants felt positively about seeing their results summarized after completion of the clinical prediction tool, but there was a need for a personalized treatment recommendation made in conjunction with a consultation with a health professional. CONCLUSIONS: User-centered design led to valuable improvements in the content and design of an app designed to improve allocation of and engagement in depression treatment. Iterative design allowed us to develop a tool that allows users to feel hope, engage in self-reflection, and motivate them to treatment. The tool is currently being evaluated in a randomized controlled trial.