JMIR Publications

ABSTRACT

Background:

In mental health care, wearable devices find their way to daily clinical practice with difficulty, even if scientific evidence is presented. Crossing the wasteland between the trial world and the real world is full of obstacles that often only become apparent during the implementation process.

Objective:

In this study, the use of an evidence-based wearable was examined in children with severe developmental problems to detect arousal related to aggressive behavior in a psychiatric treatment center. The aim was to evaluate the feasibility of this wearable in real-world clinical care and to develop forthcoming implementation strategies.

Methods:

This feasibility study with an observational-implementation hybrid approach was conducted in a psychiatric inpatient treatment center. Empatica E4 wristbands collected data on children’s psychophysiological arousal (e.g., heart rate, skin conductance). Staff reported aggressive behavior and daily activities. Data were processed and visualized in a dashboard. User experiences were assessed through interviews with clinical staff. The implementation process was evaluated using the Consolidated Framework for Implementation Research. 

Results:

A total of 30 children wore the wearable for five consecutive days, averaging 35 hours. As expected, the children found it easy to wear the device, and data collection proceeded smoothly. However, interpreting the data and utilizing the information in clinical care proved challenging, resulting in a lengthy and incremental implementation process. Strategies to overcome the obstacles focused on customizing the intervention and intensive coordination with the involved staff.

Conclusions:

The use of the wearable in a real world study setting was considered feasible and valuable. However, for broader scaling in daily clinical practice coherent actions on different domains of implementation are required.