JMIR Publications

ABSTRACT

Introduction. Military service inherently includes frequent periods of high stress training, operational tempo and sustained deployments to austere far forward environments. These occupational requirements can contribute to acute and chronic sleep disruption, fatigue, as well as behavioral health (BH) challenges related to acute and chronic stress and disruption of team dynamics. To date, there is no centralized mobile health platform that supports self- and supervised detection, monitoring, and management of sleep and BH issues in garrison and during and after deployments. The objective of this study was to adapt a clinical decision support platform for use outside clinical settings, in garrison and during field exercises, by medics and soldiers to monitor and manage sleep and BH in operational settings. Methods. To adapt an existing clinical decision support digital health platform, we first gathered system, content, and context-related requirements for a sleep and BH management system from experts. Sleep and BH assessments were then adapted for prospective digital data capture. Evidence-based and operationally relevant educational and interventional modules were formatted for digital delivery. These modules addressed the management and mitigation of sleep, circadian challenges, fatigue, stress responses, and team communication. Connectivity protocols were adapted to accommodate the absence of cellular or Wi-Fi access in deployed settings. The resulting apps were then tested in garrison and during two separate field exercises. Results. Based on identified requirements, two Android smartphone apps were adapted for self-monitoring and management for Soldiers (Soldier app) and team supervision and intervention by medics (Medic app). Two-hundred and forty six soldiers, including 28 medics received training on how to use the apps. Both apps function as expected under conditions of limited connectivity during field exercises. Areas for future technology enhancement were also identified. Conclusion. We demonstrated the feasibility of adapting a clinical decision support platform into Android smartphone-based applications to collect, save, and synthesize sleep and BH data, as well as share data using adaptive data transfer protocols when Wi-Fi or cellular data are unavailable. The AIRE prototype offers a novel self-management and supervised tool to augment capabilities for prospective monitoring, detection, and intervention for emerging sleep, fatigue, and BH issues that are common in military and non-military high-tempo occupations (e.g., submarines; long-haul flights; space station; oil rigs) where medical expertise is limited.