scholarly journals The Model of Gamification Principles for Digital Health Interventions: Evaluation of Validity and Potential Utility

10.2196/16506 ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. e16506
Author(s):  
Mark Floryan ◽  
Philip I Chow ◽  
Stephen M Schueller ◽  
Lee M Ritterband
Keyword(s):  
Behavioral Interventions ◽  
Rating Scale ◽  
Digital Health ◽  
Empirical Studies ◽  
Mobile App ◽  
Health Interventions ◽  
Potential Utility ◽  
Validity And Reliability ◽  
Web Based ◽  
App Store

Background Although gamification continues to be a popular approach to increase engagement, motivation, and adherence to behavioral interventions, empirical studies have rarely focused on this topic. There is a need to empirically evaluate gamification models to increase the understanding of how to integrate gamification into interventions. Objective The model of gamification principles for digital health interventions proposes a set of five independent yet interrelated gamification principles. This study aimed to examine the validity and reliability of this model to inform its use in Web- and mobile-based apps. Methods A total of 17 digital health interventions were selected from a curated website of mobile- and Web-based apps (PsyberGuide), which makes independent and unbiased ratings on various metrics. A total of 133 independent raters trained in gamification evaluation techniques were instructed to evaluate the apps and rate the degree to which gamification principles are present. Multiple ratings (n≥20) were collected for each of the five gamification principles within each app. Existing measures, including the PsyberGuide credibility score, mobile app rating scale (MARS), and the app store rating of each app were collected, and their relationship with the gamification principle scores was investigated. Results Apps varied widely in the degree of gamification implemented (ie, the mean gamification rating ranged from 0.17≤m≤4.65 out of 5). Inter-rater reliability of gamification scores for each app was acceptable (κ≥0.5). There was no significant correlation between any of the five gamification principles and the PsyberGuide credibility score (P≥.49 in all cases). Three gamification principles (supporting player archetypes, feedback, and visibility) were significantly correlated with the MARS score, whereas three principles (meaningful purpose, meaningful choice, and supporting player archetypes) were significantly correlated with the app store rating. One gamification principle was statistically significant with both the MARS and the app store rating (supporting player archetypes). Conclusions Overall, the results support the validity and potential utility of the model of gamification principles for digital health interventions. As expected, there was some overlap between several gamification principles and existing app measures (eg, MARS). However, the results indicate that the gamification principles are not redundant with existing measures and highlight the potential utility of a 5-factor gamification model structure in digital behavioral health interventions. These gamification principles may be used to improve user experience and enhance engagement with digital health programs.

scholarly journals The Model of Gamification Principles for Digital Health Interventions: Evaluation of Validity and Potential Utility (Preprint)

2019 ◽  
Author(s):  
Mark Floryan ◽  
Philip I Chow ◽  
Stephen M Schueller ◽  
Lee M Ritterband
Keyword(s):  
Behavioral Interventions ◽  
Rating Scale ◽  
Digital Health ◽  
Empirical Studies ◽  
Mobile App ◽  
Health Interventions ◽  
Potential Utility ◽  
Validity And Reliability ◽  
Web Based ◽  
App Store

BACKGROUND Although gamification continues to be a popular approach to increase engagement, motivation, and adherence to behavioral interventions, empirical studies have rarely focused on this topic. There is a need to empirically evaluate gamification models to increase the understanding of how to integrate gamification into interventions. OBJECTIVE The model of gamification principles for digital health interventions proposes a set of five independent yet interrelated gamification principles. This study aimed to examine the validity and reliability of this model to inform its use in Web- and mobile-based apps. METHODS A total of 17 digital health interventions were selected from a curated website of mobile- and Web-based apps (PsyberGuide), which makes independent and unbiased ratings on various metrics. A total of 133 independent raters trained in gamification evaluation techniques were instructed to evaluate the apps and rate the degree to which gamification principles are present. Multiple ratings (n≥20) were collected for each of the five gamification principles within each app. Existing measures, including the PsyberGuide credibility score, mobile app rating scale (MARS), and the app store rating of each app were collected, and their relationship with the gamification principle scores was investigated. RESULTS Apps varied widely in the degree of gamification implemented (ie, the mean gamification rating ranged from 0.17≤m≤4.65 out of 5). Inter-rater reliability of gamification scores for each app was acceptable (κ≥0.5). There was no significant correlation between any of the five gamification principles and the PsyberGuide credibility score (<i>P</i>≥.49 in all cases). Three gamification principles (supporting player archetypes, feedback, and visibility) were significantly correlated with the MARS score, whereas three principles (meaningful purpose, meaningful choice, and supporting player archetypes) were significantly correlated with the app store rating. One gamification principle was statistically significant with both the MARS and the app store rating (supporting player archetypes). CONCLUSIONS Overall, the results support the validity and potential utility of the model of gamification principles for digital health interventions. As expected, there was some overlap between several gamification principles and existing app measures (eg, MARS). However, the results indicate that the gamification principles are not redundant with existing measures and highlight the potential utility of a 5-factor gamification model structure in digital behavioral health interventions. These gamification principles may be used to improve user experience and enhance engagement with digital health programs.

scholarly journals Smartphone Apps Targeting Physical Activity in People With Rheumatoid Arthritis: Systematic Quality Appraisal and Content Analysis

10.2196/18495 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e18495 ◽  
Author(s):  
Lindsay M Bearne ◽  
Mandeep Sekhon ◽  
Rebecca Grainger ◽  
Anthony La ◽  
Mehrdad Shamali ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Physical Activity ◽  
Rating Scale ◽  
Mobile App ◽  
Information Support ◽  
World Health ◽  
Smartphone Apps ◽  
High Quality ◽  
App Store ◽  
Google Play

Background Rheumatoid arthritis (RA) is a disabling, inflammatory joint condition affecting 0.5%-1% of the global population. Physical activity (PA) and exercise are recommended for people with RA, but uptake and adherence tend to be low. Smartphone apps could assist people with RA to achieve PA recommendations. However, it is not known whether high quality, evidence-informed PA apps that include behavior change techniques (BCTs) previously identified as effective for PA adherence are available for people with RA. Objective This study aims to systematically identify apps that include goals to facilitate PA for adults with RA and assess app quality and content for the inclusion of relevant BCTs against recommendations for cardiorespiratory, resistance, flexibility, and neuromotor PA and exercise. Methods A systematic search of the Apple App Store and Google Play Store in the United Kingdom was conducted to identify English language apps that promote PA for adults with RA. Two researchers independently assessed app quality (mobile app rating scale [MARS]; range 0-5) and content (BCT Taxonomy version 1, World Health Organization, the American College of Sports Medicine, and the European League against Rheumatism recommendations for PA). The completeness of reporting of PA prescription was evaluated using a modified version of the Consensus on Exercise Reporting Template (CERT; range 0-14). Results A total of 14,047 apps were identified. Following deduplication, 2737 apps were screened for eligibility; 6 apps were downloaded (2 on the Apple App Store and 4 on the Google Play Store), yielding 4 unique apps. App quality varied (MARS score 2.25-4.17). Only 1 app was congruent with all aspects of the PA recommendations. All apps completely or partially recommended flexibility and resistance exercises, 3 apps completely or partially advised some form of neuromotor exercise, but only 2 offered full or partial guidance on cardiorespiratory exercise. Completeness of exercise reporting was mixed (CERT scores 7-14 points) and 3-7 BCTs were identified. Two BCTs were common to all apps (information about health consequences and instruction on how to perform behavior). Higher quality apps included a greater number of BCTs and were more closely aligned to PA guidance. No published trials evaluating the effect of the included apps were identified. Conclusions This review identifies 4 PA apps of mixed quality and content for use by people with RA. Higher quality apps were more closely aligned to PA guidance and included a greater number of BCTs. One high-quality app (Rheumatoid Arthritis Information Support and Education) included 7 BCTs and was fully aligned with PA and exercise guidance. The effect of apps on PA adherence should be established before implementation.

Mobile Applications in Otolaryngology: A Systematic Review of the Literature, Apple App Store and the Google Play Store

2020 ◽  
Vol 130 (1) ◽  
pp. 78-91
Author(s):  
Eleonora M. C. Trecca ◽  
Antonio Lonigro ◽  
Matteo Gelardi ◽  
Brandon Kim ◽  
Michele Cassano
Keyword(s):  
Rating Scale ◽  
Case Reports ◽  
Mobile App ◽  
App Store ◽  
Literature Reviews ◽  
Scientific Associations ◽  
Conference Papers ◽  
Further Development ◽  
Google Play

Objectives: Although the last few years have seen an increased number of smartphone applications (apps) disseminated in the field of Otolaryngology (ORL), these apps vary widely in quality. The aim of this paper, therefore, is to systematically review ORL apps directed towards patients in mobile app stores and the current literature. Methods: The Google Play Store, Apple App Store and PubMed were searched for ORL apps for patients using various keywords pertaining to different ORL subspecialties. Apps not relevant to the scope of this research and/or duplicates, educational apps, apps promoting a business, apps requiring specific separate hardware, and apps in non-English were excluded. In PubMed, keywords pertaining to the subspecialties were combined with “mobile app” in a search query; literature reviews, editorials, case reports, conference papers, duplicate articles, and articles irrelevant to ORL apps were excluded. The quality of apps with the highest number of reviews was assessed using the “Mobile App Rating Scale” (MARS), while the quality of the articles was rated using “The Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) Statement. Results: After searching the app stores, 1074 apps were included and grouped according to their ORL subspecialties. The overall MARS score of the ten most popular apps in each category was 3.65 out of 5. A total of 636 articles were identified in the literature, and 193 were included. The mean adherence percentage of the articles to the STROBE checklist was of 84.37%. Conclusions: Although the apps currently available need further development, their application in ORL appears promising. Further dialogue between physicians and patients, as well as formal support from professional and scientific associations, should be encouraged.

scholarly journals The German Version of the Mobile App Rating Scale (MARS-G): Development and Validation Study

10.2196/14479 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e14479 ◽  
Author(s):  
Eva-Maria Messner ◽  
Yannik Terhorst ◽  
Antonia Barke ◽  
Harald Baumeister ◽  
Stoyan Stoyanov ◽  
...  
Keyword(s):  
Internal Consistency ◽  
Rating Scale ◽  
Assessment Tool ◽  
Disease Onset ◽  
Mobile App ◽  
Systematic Evaluation ◽  
German Version ◽  
Validity And Reliability ◽  
Health Apps

Background The number of mobile health apps (MHAs), which are developed to promote healthy behaviors, prevent disease onset, manage and cure diseases, or assist with rehabilitation measures, has exploded. App store star ratings and descriptions usually provide insufficient or even false information about app quality, although they are popular among end users. A rigorous systematic approach to establish and evaluate the quality of MHAs is urgently needed. The Mobile App Rating Scale (MARS) is an assessment tool that facilitates the objective and systematic evaluation of the quality of MHAs. However, a German MARS is currently not available. Objective The aim of this study was to translate and validate a German version of the MARS (MARS-G). Methods The original 19-item MARS was forward and backward translated twice, and the MARS-G was created. App description items were extended, and 104 MHAs were rated twice by eight independent bilingual researchers, using the MARS-G and MARS. The internal consistency, validity, and reliability of both scales were assessed. Mokken scale analysis was used to investigate the scalability of the overall scores. Results The retranslated scale showed excellent alignment with the original MARS. Additionally, the properties of the MARS-G were comparable to those of the original MARS. The internal consistency was good for all subscales (ie, omega ranged from 0.72 to 0.91). The correlation coefficients (r) between the dimensions of the MARS-G and MARS ranged from 0.93 to 0.98. The scalability of the MARS (H=0.50) and MARS-G (H=0.48) were good. Conclusions The MARS-G is a reliable and valid tool for experts and stakeholders to assess the quality of health apps in German-speaking populations. The overall score is a reliable quality indicator. However, further studies are needed to assess the factorial structure of the MARS and MARS-G.

scholarly journals Social Cognitive Theories and Electronic Health Design: Scoping Review (Preprint)

2018 ◽  
Author(s):  
Patricia Grace-Farfaglia
Keyword(s):  
Scoping Review ◽  
Social Cognitive ◽  
Digital Health ◽  
Health Intervention ◽  
Health Interventions ◽  
Design Features ◽  
Social Design ◽  
Web Based ◽  
Cognitive Theories ◽  
Social Cognitive Theories

BACKGROUND There are several social cognitive theories (SCTs) and models that support platform design in electronic health (eHealth) promotion trials. The rationale for this scoping review was to determine how social design features (informational aid, expressive support, gaming, and tailored content) are used to promote self-efficacy, engagement, knowledge, and behavior change. OBJECTIVE This study aimed to review a broad spectrum of digital health interventions in the literature seeking trials that use SCTs for the design of eHealth applications. METHODS The author conducted a systematic scoping review of 161 Web-based health interventions from published randomized clinical trials using 1 or more tools to address the social cognitive determinants in their website design from January 2006 to April 2016. An iterative approach was used in the selection of studies and data extraction. The studies were analyzed for quality and coded for type of social design features employed. RESULTS Expressive interaction tools were found in 48.6% (54/111) of studies categorized as a strong recommendation by the Joanna Briggs Institute criteria. Overall, less than half of the studies addressed participant social support and motivational needs (43.8%). The vast majority of studies (100%) relied on the use of the Web for delivery of informational aid and tailored content for the individual participant (75.9%). CONCLUSIONS This review fills a research gap by linking social theory to Web strategy to improve the impact and sustainability of eHealth interventions. A Digital Health Intervention Model was developed to provide a framework to enhance future Web-based health intervention design and execution.

scholarly journals Facilitating User Participation in Digital Health Research: The mHealth Impact Registry

Iproceedings ◽  
10.2196/15157 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e15157
Author(s):  
Kelsey Lynett Ford ◽  
Sheana Bull ◽  
Susan L Moore ◽  
Charlene Barrientos Ortiz
Keyword(s):  
Health Status ◽  
Health Research ◽  
Digital Health ◽  
Mobile App ◽  
User Preferences ◽  
Recruitment Strategy ◽  
Underrepresented Populations ◽  
Web Based ◽  
Enrollment Process ◽  
Status Survey

Background The proliferation of technology galvanizes providers, researchers, and entrepreneurs to revolutionize health care and care delivery with diverse audiences. Digital health provides promise in improving health outcomes; however, the pace of technology requires rapid research to remain relevant in the marketplace. User experience (UX) research provides critical information about patient/client preferences while rigorous research trials demonstrate digital health efficacy. Despite the need for such research, the recruitment and enrollment process for digital health research remains time consuming and expensive, particularly when engaging underrepresented populations. Developed in the Colorado School of Public Health, the mHealth Impact Registry is a newly launched platform designed for rapid and responsive recruitment of participants for digital health research studies. While the use of registries in research is robust, the application in digital health research is quite limited. Objective This poster illustrates the development and testing of the mHealth Impact Registry’s Web-based platform, health status survey, mobile app, and participant database to reach underrepresented populations in digital health research. Methods Formative methods used a user centered approach to document user preferences for Registry design followed by iterative testing to ensure usability and navigability. Results End-user feedback was captured from multiple stakeholder groups (ie, Patient and Family Research Advisory Panel and mHealth Community Advisory Board) to refine recruitment strategy (ie, letters, video development). A health status survey was developed in both English and Spanish using the online software (ie, Qualtrics) that informs the back-end database. A detailed requirements document outlined technical and functional requirements for the mobile app (ie, iOS and Android) and Web-based platform (ie, Wordpress and Amazon Web Services). Conclusions Due to the need for rapid, rigorous, and inclusive research in digital health, a registry containing a pool of diverse participants would not only accelerate the recruitment and enrollment process but would also help to improve the reach and engagement of digital health solutions for underrepresented populations. The mHealth Impact Registry would house diverse participants, supporting quick enrollment and active participation in studies for which they are eligible. Improving the accessibility of participants and the speed of enrollment has promise in ensuring digital health solutions are relevant upon dissemination and commercialization.

scholarly journals Vaping-Related Mobile Apps Available in the Google Play Store After the Apple Ban: Content Review

10.2196/20009 ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. e20009
Author(s):  
Meredith C Meacham ◽  
Erin A Vogel ◽  
Johannes Thrul
Keyword(s):  
Rating Scale ◽  
Mobile Apps ◽  
Mobile App ◽  
Sources Of Information ◽  
App Store ◽  
Quit Smoking ◽  
Quitting Smoking ◽  
Do It Yourself ◽  
Content Review ◽  
Google Play

Background In response to health concerns about vaping devices (eg, youth nicotine use, lung injury), Apple removed 181 previously approved vaping-related apps from the App Store in November 2019. This policy change may lessen youth exposure to content that glamorizes vaping; however, it may also block important sources of information and vaping device control for adults seeking to use vaping devices safely. Objective Understanding the types of nicotine and cannabis vaping–related apps still available in the competing Google Play Store can shed light on how digital apps may reflect information available to consumers. Methods In December 2019, we searched the Google Play Store for vaping-related apps using the keywords "vape" and "vaping" and reviewed the first 100 apps presented in the results. We reviewed app titles, descriptions, screenshots, and metadata to categorize the intended substance (nicotine or cannabis/tetrahydrocannabinol) and the app’s purpose. The most installed apps in each purpose category were downloaded and evaluated for quality and usability with the Mobile App Rating Scale. Results Of the first 100 apps, 79 were related to vaping. Of these 79 apps, 43 (54%) were specific to nicotine, 3 (4%) were specific to cannabis, 1 (1%) was intended for either, and for the remaining 31 (39%), the intended substance was unclear. The most common purposes of the apps were making do-it-yourself e-liquids (28/79, 35%) or coils (25/79, 32%), games/entertainment (19/79, 24%), social networking (16/79, 20%), and shopping for vaping products (15/79, 19%). Of the 79 apps, at least 4 apps (5%) paired with vaping devices to control temperature or dose settings, 8 apps (10%) claimed to help people quit smoking using vaping, and 2 apps (3%) had the goal of helping people quit vaping. Conclusions The majority of vaping-related apps in the Google Play Store had features either to help users continue vaping, such as information for modifying devices, or to maintain interest in vaping. Few apps were for controlling device settings or assisting with quitting smoking or vaping. Assuming that these Google Play Store apps were similar in content to the Apple App Store apps that were removed, it appears that Apple’s ban would have a minimal effect on people who vape with the intention of quitting smoking or who are seeking information about safer vaping via mobile apps.

scholarly journals Influence of Animation- Versus Text-Based Delivery of a Web-Based Computer-Tailored Smoking Cessation Intervention on User Perceptions

2021 ◽  
Vol 2 (3) ◽  
pp. 1-23
Author(s):  
Jan Mathis Elling ◽  
Hein De Vries
Keyword(s):  
Smoking Cessation ◽  
Digital Health ◽  
Mode Of Delivery ◽  
Text Messages ◽  
Smoking Cessation Intervention ◽  
Health Interventions ◽  
Web Based ◽  
User Perceptions ◽  
Cessation Intervention ◽  
Text Condition

Computer-tailored (CT) digital health interventions have shown to be effective in obtaining behaviour change. Yet, user perceptions of these interventions are often unsatisfactory. Traditional CT interventions rely mostly on text-based feedback messages. A way of presenting feedback messages in a more engaging manner may be the use of narrated animations instead of text. The goal of this study was to assess the effect of manipulating the mode of delivery (animation vs. text) in a smoking cessation intervention on user perceptions among smokers and non-smokers. Smokers and non-smokers (N = 181) were randomized into either the animation or text condition. Participants in the animation condition assessed the intervention as more effective (ηp2 = .035), more trustworthy (ηp2 = .048), more enjoyable (ηp2 = .022), more aesthetic (ηp2 = .233), and more engaging (ηp2 = .043) compared to participants in the text condition. Participants that received animations compared to text messages also reported to actively trust the intervention more (ηp2 = .039) and graded the intervention better (ηp2 = .056). These findings suggest that animation-based interventions are superior to text-based interventions with respect to user perceptions.

scholarly journals Analysis of Secure Apps for Daily Clinical Use by German Orthopedic Surgeons: Searching for the "Needle in a Haystack" (Preprint)

2019 ◽  
Author(s):  
Florian Dittrich ◽  
Sascha Beck ◽  
Anna Katharina Harren ◽  
Felix Reinecke ◽  
Sebastian Serong ◽  
...  
Keyword(s):  
Rating Scale ◽  
Mobile App ◽  
High Quality ◽  
Clinical Routine ◽  
Health Apps ◽  
App Store ◽  
Orthopedic Surgeons ◽  
Future Challenges ◽  
Mobile Health Apps

BACKGROUND It is undeniable that appropriate smartphone apps offer enormous opportunities for dealing with future challenges in orthopedic surgery and public health, in general. However, it is still unclear how the apps currently available in the two major app stores can be used in daily clinical routine by German orthopedic surgeons. OBJECTIVE This study aimed to gain evidence regarding the quantity and quality of apps available in the two major app stores and their suitability for use by orthopedic surgeons in Germany. METHODS We conducted a systematic, keyword-based app store screening to obtain evidence concerning the quantity and quality of commercially available apps. Apps that met the inclusion criteria were evaluated using the <i>app synopsis–checklist for users</i> and the German Mobile App Rating Scale for secure use, trustworthiness, and quality. RESULTS The investigation revealed serious shortcomings regarding legal and medical aspects. Furthermore, most apps turned out to be useless and unsuitable for the clinical field of application (4242/4249, 99.84%). Finally, 7 trustworthy and high-quality apps (7/4249, 0.16%) offering secure usage in the daily clinical routine of orthopedists were identified. These apps mainly focused on education (5/7). None of them were CE (Conformité Européenne) certified. Moreover, there are no studies providing evidence that these apps have any positive use whatsoever. CONCLUSIONS The data obtained in our study suggest that the number of trustworthy and high-quality apps on offer is extremely low. Nowadays, finding appropriate apps in the fast-moving, complex, dynamic, and rudimentarily controlled app stores is most challenging. Promising approaches, for example, systematic app store screenings, app-rating developments, reviews or app libraries, and the creation of consistent standards have been established. However, further efforts are necessary to ensure that these innovative mobile health apps not only provide the correct information but are also safe to use in daily clinical practice.

Digital health interventions in prevention, relapse and therapy of mild and moderate depression – a scoping review (Preprint)

2020 ◽  
Author(s):  
Pinar Tokgöz ◽  
Robert Hrynyschyn ◽  
Jessica Hafner ◽  
Simone Schönfeld ◽  
Christoph Dockweiler
Keyword(s):  
Behavior Therapy ◽  
Cognitive Behavior Therapy ◽  
Scoping Review ◽  
Relapse Prevention ◽  
Digital Health ◽  
Health Interventions ◽  
Cognitive Behavior ◽  
Comprehensive Overview ◽  
Web Based ◽  
Treatment Of Depression

BACKGROUND Depression is a major cause for disability worldwide and digital health interventions are expected to be a more augmentative and effective treatment. According to the fast-growing field of information and communication technologies and its dissemination, there is a need of mapping the technological landscape, as well as its benefits and challenges for users. OBJECTIVE A scoping review was conducted to provide a comprehensive overview in the field of digital health interventions for the treatment of depression. The purpose of this scoping review was to give an overview of the used DHI for depression. The main goal of this review was then to provide a comprehensive review of the system landscape and its technological state and functions, as well as its evidence and benefits for users. METHODS A scoping review was conducted to provide a comprehensive overview in the field of digital health interventions for the treatment of depression. PubMed, Psyndex, and Cochrane were searched by two independent researchers between May 2019 and April 2019 to identify relevant publications and were examined due to inclusion and exclusion criteria. For conducting the systematic review, ‘Rayyan’, a free web-tool, was used. RESULTS In total, 51 studies were included in the qualitative synthesis. After categorizing the field of application in prevention, early detection, therapy and relapse prevention, the search showed dominant numbers of studies in the field therapy (N= 42). There was only one prevention study, three studies for early detection and five studies for relapse prevention. Dominant measures of depression severity were the PHQ-9 or the BDI-II scale. The most dominant therapy approaches were cognitive behavior therapy, acceptance and commitment therapy and problem-solving therapy. Most of the studies revealed significant effects of digital health intervention when cognitive behavior therapy applied. cognitive behavior therapy as the most dominant form was often provided by web-based systems. Combined approaches consisting of web-based and smartphone-based approaches are constantly rising. CONCLUSIONS Digital health interventions for treating depression are quite comprehensive. There are different interventions focusing on different fields of care. While most applications can be beneficial to achieving a better care for depression patients, it can be hindering in determining which approaches in the depression care are suitable. Computerized CBT has shown good effects in the treatment of depression, but treatment for depression still stays very individualistic.

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