Targeting the Needs of Self-Determination Theory: An Overview of Mental Health Care Apps
DOI:
https://doi.org/10.5708/EJMH/17.2022.1.8Keywords:
mHealth, depression, mobile applications, the Self-Determination Theory, SDTAbstract
Introduction: Smartphone apps are a highly accessible tool to supplement self-treatment for mental health challenges, such as depression, and are underrepresented in research. While many studies have performed content analyses of health apps, few studies have reviewed their adherence to behavior theory.
Aims: The objective of this study is to assess mHealth depression apps through the lens of the Self-Determination Theory and identify if app functions target the three basic needs: autonomy, competence, and relatedness.
Methods: All depression apps available from iTunes and Google Play that met inclusion criteria were analyzed (N = 194). Apps were reviewed for price options, store availability, download rates, and how functions targeted the three basic needs for intrinsic and sustained health behavior change outlined in the Self-Determination Theory.
Results: Findings showed that most of the apps targeted at least one of the basic needs (158/194, 81.4%). However, only a few of these apps targeted all three basic needs to some degree (15/194, 7.7%), and no single app targeted all three basic needs fully. Furthermore, neither store availability, price option nor download rates were accurate predictors that apps targeted the three basic needs.
Conclusions: The results suggest that some depression apps targeted autonomy, competence, and relatedness but this was limited to a small number of apps through few functions available in each app. People who want access to more functions targeting the needs would need to download a suite of apps.
References
Bartholomew, K. J., Ntoumanis, N., Ryan, R. M., Bosch, J. A., & Thøgersen-Ntoumani, C. (2011). Self-Determination Theory and diminished functioning: The role of interpersonal control and psychological need thwarting. Personality & Social Psychology Bulletin, 37(11), 1459–1473.
https://doi.org/10.1177/0146167211413125
Britton, P. C., Williams, G. C., & Conner, K. R. (2008). Self‐Determination Theory, motivational interviewing, and the treatment of clients with acute suicidal ideation. Journal of Clinical Psychology, 64(1), 52–66.
https://doi.org/10.1002/jclp.20430
Burchert, S., Kerber, A., Zimmerman, J., & Knaevelsrud, C. (2021). Screening accuracy of a 14-day smartphone ambulatory assessment of depression symptoms and mood dynamics in a general population sample: Comparison with the PHQ-9 depression screening. PloS One, 16(1), e0244955.
https://doi.org/10.1371/journal.pone.0244955
Deng, Z., Mo, X., & Liu, S. (2014). Comparison of the middle-aged and older users’ adoption of mobile health services in China. International Journal of Medical Informatics, 83(3), 210–224.
https://doi.org/10.1016/j.ijmedinf.2013.12.002
Eysenbach, G., Kangas, M., & Jämsä. T. (2020). A persuasive mHealth behavioral change intervention for promoting physical activity in the workplace: Feasibility randomized controlled trial. JMIR Formative Research, 4(5), e15083.
https://doi.org/10.2196/15083
Fish, M. T., & Saul, A. D. (2019). The gamification of meditation: A randomized-controlled study of a prescribed mobile mindfulness meditation application in reducing college students’ depression. Simulation & Gaming, 50(4), 419–435.
https://doi.org/10.1177/1046878119851821
Fogel, J., Albert, S. M., Schnabel, F., Ditkoff, B. A., & Neugut, A. I. (2002). Internet use and social support in women with breast cancer. Health Psychology, 21(4), 398–404.
https://doi.org/10.1037/0278-6133.21.4.398
Grossman, J. T., Frumkin, M. R., Rodebaugh, T. L., & Lenze, E. J. (2020). mHealth assessment and intervention of depression and anxiety in older adults. Harvard Review of Psychiatry, 28(3), 203–214.
https://doi.org/10.1097/HRP.0000000000000255
Harrer, M., Apolinárió-Hagen, J., Fritsche, L., Salewski, C., Zarski, A-C., Lehr, D., Baumeister, H., Cuijpers, P., & Ebert, D. D. (2021). Effect of an internet-and app-based stress intervention compared to online psychoeducation in university students with depressive symptoms: Results of a randomized controlled trial. Internet Interventions, 24, 100374.
https://doi.org/10.1016/j.invent.2021.100374
Knapton, S. (2015, October 12). Most NHS depression apps are unproven, warn health experts. The Telegraph.
https://www.telegraph.co.uk/news/nhs/11926616/Most-NHS-depression-apps-are-unproven-warn-health-experts.html
Larsen, M. E., Nicholas, J., & Christensen, H. (2016) Quantifying app store dynamics: Longitudinal tracking of mental health apps. JMIR mHealth and uHealth, 4(3), e96.
https://doi.org/10.2196/mhealth.6020
Larson, R. S. (2018). A path to better-quality mHealth apps. JMIR mHealth and uHealth, 6(7), e10414.
https://doi.org/10.2196/10414
Leigh, S., & Flatt, S. (2015). App-based psychological interventions: Friend or foe? Evidence Based Mental Health, 2015(18), 97–99.
https://doi.org/10.1136/eb-2015-102203
Levesque, C. S., Williams, G. C., Elliot, D., Pickering, M. A., Bodenhamer, B., & Finley, P. J. (2007). Validating the theoretical structure of the Treatment Self-Regulation Questionnaire (TSRQ) across three different health behaviors. Health Education Research, 22(5), 691–702. https://doi.org/10.1093/her/cyl148
Li, L. S. E., Wong, L. L., & Yap, K. Y-L. (2021). Quality evaluation of stress, anxiety and depression apps for COVID-19. Journal of Affective Disorders Reports, 6, 100255.
https://doi.org/10.1016/j.jadr.2021.100255
Logsdon, M. C., Usui, W., Pinto-Foltz, M., & Rakestraw, L. (2009). Intention to seek depression treatment in adolescent mothers and a comparison group of adolescent girls. Archives of Psychiatric Nursing, 23(1), 41–49.
https://doi.org/10.1016/j.apnu.2008.02.013
Mazure, C. M., Bruce, M. L., Maciejewsky, P. K., & Jacobs, S. C. (2000). Adverse life events and cognitive-personality characteristics in the prediction of major depression and antidepressant response. American Journal of Psychiatry, 157(6), 896–903.
https://doi.org/10.1176/appi.ajp.157.6.896
McCartney, M. (2013). How do we know whether medical apps work? BMJ, 2013, 346, f1811.
https://doi.org/10.1136/bmj.f1811
Mehta, A., Niles, A. N., Vargas, J. H., Marafon, T., Couto, D. D., & Gross, J. J. (2021). Acceptability and effectiveness of artificial intelligence therapy for anxiety and depression (Youper): Longitudinal observational study. Journal of Medical Internet Research, 23(6), e26771.
https://doi.org/10.2196/26771
Monney, G., Pezenstadler, L., Dupraz, O., Etter, J.-F., & Khazaal, Y. (2015). mHealth app for cannabis users: Satisfaction and perceived usefulness. Frontiers in Psychiatry, 6, 120.
https://doi.org/10.3389/fpsyt.2015.00120
Pinheiro, M., Serra, M., & Pereira-Azevedo, N. (2019) Predictors of the number of installs in psychiatry smartphone apps: Systematic search on app stores and content analysis. JMIR Mental Health, 6(11), e15064.
https://doi.org/10.2196/15064
Powell, A. C., Torous, J., Chan, S., Raynor, G. S., Shwarts, E., Shanahan, M., & Landman, A. B. (2016). Interrater reliability of mHealth app rating measures: Analysis of top depression and smoking cessation apps. JMIR Mhealth and Uhealth, 4(1), e15.
https://doi.org/10.2196/mhealth.5176
ReachOut Australia (2020). Moodpath: About the app.
https://au.reachout.com/tools-and-apps/moodpath
Rothman, A. J. (2000). Toward a theory-based analysis of behavioral maintenance. Health Psychology, 19(1s), 64–69.
https://doi.org/10.1037/0278-6133.19.suppl1.64
Ryan, R. M., & Deci, E. L. (2008). A Self-Determination Theory approach to psychotherapy: The motivational basis for effective change. Canadian Psychology/Psychologie canadienne, 49(3), 186–193.
https://doi.org/10.1037/a0012753
Ryan, R. M., Patrick, H., Deci, E. L., & Williams, G. C. (2008). Facilitating health behaviour change and its maintenance: Interventions based on Self-Determination Theory. The European Health Psychologist, 10(1), 2–5.
Ryu, I. (2012, February 13). ‘Depression app’ I thought it was fun, but I just wanted to die. Kyunghyang Newspaper.
http://news.khan.co.kr/kh_news/khan_art_view.html?artid=201202122141395&code=940601
Sama, P. R., Eapen, Z. J., Weinfurt, K. P., Shah, B. R., & Schulman, K. A. (2014). An evaluation of mobile health application tools. JMIR mHealth and uHealth, 2(2), e19.
https://doi.org/10.2196/mhealth.3088
Schiffrin, H. H., Erchull, M. J., Sendrick, E., Yost, J. C., Power, V., & Saldanha, E. R. (2019). The effects of maternal and paternal helicopter parenting on the self-determination and well-being of emerging adults. Journal of Child and Family Studies, 28, 3346–3359.
https://doi.org/10.1007/s10826-019-01513-6
Shen, N., Levitan, M.-J., Johnson, A., Bender, J. L., Hamilton-Page, M., Jadad, A. R., & Wiljer, D. (2015). Finding a depression app: A review and content analysis of the depression app marketplace. JMIR mHealth and uHealth, 3(1), e16.
https://doi.org/10.2196/mhealth.3713
Umaefulam, V., & Premkumar, K. (2020). Impact of mobile health in diabetic retinopathy awareness and eye care behavior among Indigenous women. mHealth, 2020(6), 14.
https://doi.org/10.21037/mhealth.2019.12.01
Wali, S., Demers, C., Shah, H., Wali, H., Lim, D., Naik, N., Ghany, A., Vispute, A., Wali, M., & Keshavjee, K. (2019). Evaluation of heart failure apps to promote self-care: Systematic app search. JMIR mHealth and uHealth, 7(11), e13173.
https://doi.org/10.2196/13173
Williams, N. (2014). The Oxford handbook of health communication, behavior change, and treatment adherence. Occupational Medicine, 64(6), 475.
https://doi.org/10.1093/occmed/kqu088
Youper Inc. (2020). Feel your best with Youper AI therapy: AI therapy is modern mental health care.
https://www.youper.ai/
