Towards the Design of a Mobile Mental Health Self-help System
for Emergency Rescuers
A Pilot Study
Manning Li and Jie Hou
School of Business Administration, Northeastern University, Shenyang, China
School of Information Science and Engineering, Northeastern University, Shenyang, China
Keywords: Social Impacts of Information Systems, Human Computer Interaction, Design Science Paradigm,
Emergency Rescuers, Mental Health Self-help Systems.
Abstract: This study explores the psychological need of emergency rescuers and proposes a strategy for addressing
these needs through intelligent virtual advisory tools named ERMS. Drawing on the design science
paradigm in the information systems discipline, we explore the key design principals that influence the
value of the mental self-help system, through iterations of the user requirements elicitation, system design,
development and theory testing. This paper focuses on a systematic review of the contemporary research
work that weave together to inform our research emphasis and system design. In the next stage, we will
propose our research framework, then testing the framework further through large scale experiments. This
paper contributes to the advancement of Information Systems theories in the design of virtual advisory
systems. It also highlights to practitioners a few important practical guidelines for the design and
development of virtual advisory systems.
1 INTRODUCTION
When disaster happens, a large number of
emergency rescuers need to urgently react to this
situation and rush to the field of disasters. In face of
extreme stressors such as catastrophic scenes,
disaster victims and intense work-load, there is a
high chance (around 1/3) that they will suffer from
Acute Stress Disorder (ASD), which, without timely
and proper intervention, can develop into life-long
chronic mental problems(Te Brake et al., 2009).
However due to a lack of qualified psychologists in
developing countries, we do not have enough
resources to carry out large-scale intervention
strategies.
Inspired by the recent champion of online
psychological therapies in developed countries such
as UK and Australia, our study sets out to explore,
following the IS design science paradigm, how to
design an effective online mental health self-help
system to empower rescuers in developing countries
– so that it facilitates their healing, personal growth
and mental well-being to be able to continue their
invaluable service to the community.
This study is also enlightened by the recent
emergence of a large number of virtual advisory
services in many fields, such as healthcare, travel,
commerce and academia. These virtual advisory
services play a vital role in people’s lives by
providing timely and effective advice for users to
accomplish a variety of tasks. However, to our
knowledge, there is little study that systematically
studied the design principals and the social impact of
mobile mental health self-help systems for
emergency rescuers.
Motivated by the urgent need in practice and the
gaps in literature, we propose a mobile Emergency
Rescuer Mental health Self-help system (ERMS) to
provide psychological first-aid to rescuers, in terms
of personalized stress-relief and health promotion
strategies. With the mobile ERMS, people can have
access to self-help information anytime, anywhere
and anyhow, which ensures interoperability,
ubiquity, security and adaptivity (Yahmed et al.,
2013). Consequently, in this paper we mainly
explore: What are the key factors in the system
design that influence the value of ERMS?
Overall, we expect that the study of the design
principals for online mental health self-help system
for emergency rescuers through the lens of design
465
Li M. and Hou J..
Towards the Design of a Mobile Mental Health Self-help System for Emergency Rescuers - A Pilot Study.
DOI: 10.5220/0004911404650472
In Proceedings of the International Conference on Health Informatics (HEALTHINF-2014), pages 465-472
ISBN: 978-989-758-010-9
Copyright
c
2014 SCITEPRESS (Science and Technology Publications, Lda.)
science theory has significant contributions to both
theory and practice. Besides, it is important to note
that mental self-help systems are frequently used to
complement existing psychological resources in the
national health framework, rather than aiming at
replacing those health services provided by
professionals.
In the following sections, we first review the
theoretical background related to the design of
ERMS. Following the design science paradigm, we
present the detailed design principals for ERMS
which evolve from the elicitation of insights from
emergency rescuers using semi-structured in-depth
interviews. Finally, we discuss the implications of
the research and future research directions.
2 THEORETICAL
BACKGROUND
2.1 Existing Work
Virtual advisory services have been widely adopted
in many areas such as commerce, healthcare, travel
and education. With their interactive nature, people
can easily adapt to such services. In the modern
society, especially in developing countries that strive
for fast pace of growth, stress from career and life
are common for many people. Virtual health
advisory services have been well received by people
with various health concerns. Consequently, there is
a continued and growing research emphasis on the
virtual advisory services in the healthcare area (Riva,
2005). Several representative studies are briefly
discussed below.
The virtual doctor ‘freeMD’ looks like a real
physician, underneath which is an expert system and
a comprehensive medical database (Schueler, 2013).
FreeMD performs medical interviews like a real
doctor, users should answer questions about
symptoms, after the interview, it will generate a
report about the cause of your symptoms and when
and where you should seek care. It mainly helps
users determine the most appropriate time and place
to receive care from a healthcare professional.
However it has limited functionality and lengthy
questions.
Another interesting example is the website
named depressed little prince, established by the
University of Hong Kong (DLP, 2013). Through the
website, users can know some basic knowledge of
depression and check their own emotional health.
Users can also share their experiences and gain
insights from other users. The website also provides
some FAQs about depression, you can learn more by
opening the “Door of Answers”. This website is
quite attractive and very helpful to the depressed
person, but it only fits for people with depression
and lacks of interactivity.
Those discussed virtual services above are all
based on the personal computer (PC), as the rapid
development of mobile device, people pay great
attention on the mobile applications services, using
of mobile computing and communication
technologies in healthcare, which called the m-health
(Phillips et al., 2010). Through m-health, people can
establish a relationship with the health experts, who
can provide efficient and timely medical assistance.
There have been many researches in m-health.
Mattila and her colleagues (Mattila et al., 2010)
propose a mobile application for personal health
management named Wellness Diary (WD). Self-
observation and feedback are WD’s two main
mechanisms. It can record self-observations related
to health and behaviour, such as sleep, stress,
smoking, weight, blood pressure and alcohol
consumption. The application can automatically
generate the graphical feedback based on the
collected data to users. Because of WD’s simplicity,
mobility and fast and easy usage independent of
location and time, WD is quite popular with people.
Another interesting mobile application is called
UAHealth, which is designed and developed by
Milošević and colleagues (Milošević et al., 2011).
The application communicates through a set of
sensors (low power ANT+ wireless standard with
commercially available off-the-shelf sensors) in the
wireless environment, it can work both online and
offline. UAHealth is designed to monitor people’s
physiological signals, such as people’s weight, heart
activity and physical activity. These collected data
can be accessed by users and medical professionals,
in order to get some professional advices from the
professors.
Table 1 in the appendix presents a summary of some
relevant empirical studies in the healthcare self-services
area, outlining the context, major functions, advantages
and disadvantages. The table compares the strengths and
weaknesses of each design constructs, so that we can keep
the positive attributes and remove the negatives. Inspired
by these researches, we design and develop ERMS based
on the Android platform, in order to research the key
factors in the system design that influence the value of the
virtual advisory service.
2.2 Design Principals for the Virtual
Advisory System
Design science research (DSR) has become an
HEALTHINF2014-InternationalConferenceonHealthInformatics
466
increasingly important paradigm in the Information
System research field (Gregor and Hevner, 2013).
Design science is inherently a problem solving
process, which aims at creating new and innovative
artifacts, and expanding the boundaries of human
and organizational capacity. In the DSR, knowledge
and understanding of a problem domain and
solutions can be achieved in the building and
application of the design artefact (Hevner et al.,
2004). Hevner proposed a view of design science,
which is an embodiment of three closely related
cycles of activities. The discussed three cycles are
the Relevance Cycle, the Rigor Cycle and the central
Design Cycle (see Figure 1).
The relevance cycle uses the requirement for the
research from the application context as the inputs,
and introduces the acceptance criteria for the
research results’ evaluation. It bridges the contextual
environment with the design science activities. The
rigor cycle provides the grounding theories and past
knowledge to the research projects and adds the
knowledge to the growing knowledge base. It
connects the design science activities with the
knowledge base of the research project. The internal
design cycle is the heart of the design science
research project, which iterates between the core
activities and evaluation of design ‘artifacts’ and
processes of the research. The hard work of design
science research is mainly done in the design(Hevner,
2007).
Figure 1: Design Science Research Cycles(Image based on
(Hevner, 2007)).
Following the design science paradigm, we design
our system prototype and explore the key values of
mobile mental self-help system (See Table 2 in
Appendix).
3 THE DESIGN OF MOBILE
MENTAL HEALTH SELF-HELP
SYSTEM
Following the design science paradigm, we take an
iterative/innovative approach in system requirements
elicitation, design and testing/feedback. Following
the publication schema for a design science research
study in MIS Quarterly (Gregor and Hevner, 2013),
the artifact description section gives a description of
the design artifact and the design search process,
which leads to the discovery of the artifact design
and demonstration of its credibility. We elaborate
this non-linear and iterative process based on the
three cycles as proposed by (Hevner, 2007).
3.1 Relevance Cycle
In order to design the mobile ERMS, we begin with
interviewing ten emergency rescuers working in the
fire brigade in Dandong, China. The average age of
the participants is 25 years old. When we arrived at
the interview site, we were told that due to the
special nature of this occupation, most of the on-site
rescuers are male. Thus, our interview participants
are males and most of their education levels are
senior high school (eight), with only two people
graduated from colleges. Their working experiences
in the rescue field ranges from 2 to 10 years. We
took a semi-structured and in-depth approach to
interview each emergency rescuer, lasting from 30
minutes to 50 minutes. Open, axial and selective
coding methods were used to analyze the transcribed
interview data (Glaser and Strauss, 2009). Based on
the feedback from the respondents, we found several
important themes emerged from these in-depth
discussions:
·Emergency rescuers, especially novice employees,
frequently experience fear, lack of confidence and
feelings of anxiety. They frequently experience
nightmare that reproduce the event after rescue tasks.
·The emergency rescuers have a pressing need to
have more convenient access to relevant support and
knowledge for maintaining their psychological well-
being. However, most people being interviewed have
biased attitudes towards mental health knowledge,
they can’t treat psychological problems properly.
They have concerns about the psychological
counselling, and often conceal their ailment and
refuse to consult the doctor. Further, most of the new
recruits haven't received sufficient formal training on
mental health.
·Meanwhile, there is a lack of effective observation
and treatment for new recruits’ psychological
situation in most cases. Many people mainly rely on
themselves or talking to friends and fellow
employees to alleviate their negative emotions,
which frequently can’t obtain the expected effect. It
is also mentioned that some people resign or change
their positions on account of the great psychological
TowardstheDesignofaMobileMentalHealthSelf-helpSystemforEmergencyRescuers-APilotStudy
467
pressure. Finally, there are no effective measures to
monitor rescuers’ physical and mental condition in
terms of large-scale intervention strategies.
To address these afore-mentioned issues,
respondents suggested the below functionalities for
ERMS, including:
· Providing tailored professional psychology
knowledge targeted at the rescuer occupation,
displaying these information and knowledge lively
and intuitively either in form of text, video or
animation to give them a sense of human warmth
and support.
·Having functions that support psychological self-
assessment, and capabilities to generate personalized
health evaluation report for further references.
·Monitoring the emergency rescuers’ physical and
mental indices with mobile devices or portable
hardware devices.
· Displaying physiological data that reflects the
mental status of rescuers intuitively in the form of
graph or column diagram, and providing practical
advices timely and effectively.
· Taking precautions to adjust psychological
pressure for rescuers, such as communicating with
an intelligent virtual advisor to enhance their sense
of control and self-efficacy in dealing with negative
emotions.
3.2 Rigor Cycle
Design science is born from a large number of
scientific theories and engineering knowledge base.
The knowledge base contains the experiences and
expertise that define the state-of-the-art in the
research domain, and the existing artifacts and
processes in the application domain (Hevner, 2007).
In this research, we mainly explore from the
information systems literature, the key factors in the
system design that influence the value of virtual
advisory system (see Table 2), as elaborated in detail
below.
Social presence refers to the extent to which an
artifact is perceived as sociable, warm, personal, or
intimate when interacting with it (Gefen and Straub,
2003). Cyr empirically showed that people have a
higher sense of involvement when contacting with a
human-like element in the virtual environment,
which result in a sense of social presence(Cyr et al.,
2009). This design theory is just suitable for
emergency rescuers. In the relevance cycle, we
investigate that the rescuers hope to communicate
with a virtual advisor, who can make users feel
warm and sociable.
Personalization is applicable to any browsing
activity, it can be defined as any action that tailors
the experience to a particular user. The action can
range from making the presentation more pleasing to
providing customized information and anticipating
the needs of a user (Mobasher et al., 2000). Theng
has proposed that the design should be made more
user-focused and centered. Designers of the systems
should allow users to build trust, but also to
encourage trustworthy behaviour among users
(Theng et al., 2012). This design theory caters for
users’ requirements, which can make emergency
rescuers feel personalized when communicating with
the virtual advisor.
Perceived transparency refers to the extent to
which the content is perceived by the user as easy to
read and understand. This relates to people’s
background knowledge, presentation of the content,
use of examples in explanation and the inclusion of
graphics (Xu and Chen, 2006). This design method
can reduce the communication barriers, which can
enhance the sense of social presence, so as to learn
the psychological knowledge better.
Self-efficacy plays an important role in
determining people’s choice of strategies in face of
challenging situations. Literatures suggested that
virtual advisory systems for domestic violence
victims can help with enhancing their self-efficacy in
getting out of abuse. Consequently, we expect that
emergency rescuers can gain higher self-efficacy in
dealing with negative emotions after using the
ERMS.
Furthermore, engagement (Sidner et al., 2005),
sense of control (Koufaris, 2002), trustworthiness
(Al-Natour et al., 2011) and perceived
persuasiveness
(Mazzotta et al., 2007) are all
considered key factors by prior studies in
information system design that potentially influence
the value of ERMS.
These design principals from existing theory
inform the design of ERMS, as discussed below.
3.3 Design Cycle
In Section 2 we reviewed existing work in the virtual
advisory system, analyzing the advantages and
disadvantages in designing the healthcare self-
service systems. In addition, we conducted semi-
structured and in-depth interviews with emergency
rescuers to probe for insights for the system design.
Synthesizing these findings from literature and
practice, we propose the design for the mobile
ERMS, which is a tool that specifically targeted at
supporting the psychological need of emergency
HEALTHINF2014-InternationalConferenceonHealthInformatics
468
rescuers. The ERMS is developed based on the
Android platform. Users can access the service
whenever and wherever they wish to, due to the high
portability of the mobile end-user devices. This
corresponds to the ubiquitous design features on
account of the mobile platform as raised in user
requirements. The system should support emergency
rescuers in easing their psychological pressure
timely and conveniently to ensure sustained mental
health wellbeing of these rescuers.
The ERMS primarily contains six important
functions, including consultation service, self-
assessment, supplementary answer, self-testing and
physiological monitoring (see the picture on the left
in Figure 2). Several exemplar screenshots of the
system are presented below.
After interviewing the emergency rescuers, we
found that they would like the system to incorporate
psychological assessment functions. Consequently,
we design the self-assessment function. Through
self-testing, users can obtain timely and personalized
understanding towards their own psychological
status ， and the system will give some further
professional advices for user reference (see the
picture on the right in Figure 2), which can make
users feel a sense of control over their personal
situation through reading the detailed personal
analysis report.
Figure 2: Main menu and self-assessment quizes in ERMS.
Except for the need of self-assessment, emergency
rescuers are also eager to learn about psychological
knowledge. Figure 3 shows the function of
knowledge inquiry, which is mainly used for
learning some fundamental psychology knowledge,
such as depression, insomnia and anxiety. When the
user clicks on the corresponding entry, he/she can
explore the knowledge more in-depth. In this way,
the system is designed to cater for individual users’
need for learning. Furthermore, emergency rescuers
can gain a better sense of support and control over
their own situations after experiencing the ERMS.
Prior discussions on literature and rescuer
insights indicate that the virtual advisory services
should include the interactive function, which can
Figure 3: Knowledge inquiry functions in ERMS.
make users perceive a sense of social presence. Our
mobile ERMS is also a kind of virtual advisory
service that can provide the psychological
knowledge and advices for emergency rescuers.
Hence, our system should design a virtual advisor
who has rich three-dimensional animated facial
expressions and can communicate through both
voice and text, which can make users feel like
interacting with a real person to enhance the sense of
social presence and transparency. Figure 4 shows
exemplar screenshots for the consultation service.
The virtual advisors can communicate with the users
by voice and text. We choose the voice package of
company iFLYTEK, which can make the users enjoy
the fluent speech communication. In addition, the
advisor can show different facial expressions and
movements. This corresponds to the requirements of
interactive system design and the rescuers’ need for
communicating with a virtual advisor who can adjust
their pressures. Such a system design can enable
users to feel social presence, personalized and
engagement so as to relieve their own psychological
problems effectively.
Figure 4: Interactive virtual advisory functions in ERMS.
During the process of communicating with the
virtual advisor, if the advisor doesn’t know how to
answer, the system will submit the questions into the
supplementary answer functional module (Figure 5).
Users can provide their own answers or inquire other
users’ solutions. If the user is satisfied with the
answer, he/she can click the ‘support’ button to
TowardstheDesignofaMobileMentalHealthSelf-helpSystemforEmergencyRescuers-APilotStudy
469
increase the probability of the answers to be adopted.
This function can produce a sense of interactivity
and replenish detailed knowledge for users.
Figure 5: Functions of trainig the virtual advisor in ERMS.
Figure 6: Monitoring psysiological signs.
From existing studies and rescuer interviews, we
found that it is important to allow emergency
rescuers to monitor their physiological and mental
indices anywhere and anytime. Thus, in order to
monitor emergency rescuers’ physiological signs, we
use a medical device that can measure heart rate (HR)
and heart rate variability (HRV), which can be read
by mobile smartphones with bluetooth data
communication (see figure 6). These physiological
data is presented in the form of graphs and tables,
thus users can understand their own health condition
at a glance. According to these collected data, we
analyze and come up with personalize measures for
emergency rescuers. In exceptional situations, if
there is something more serious with a emergency
rescuer, the system will help him/her determine the
appropriate place and time to receive professional
advice. Then this ERMS become a complementary
support for the existing mental health support
framework in the society.
Overall, the ERMS uses the design science
philosophy from literature for reference, and
considers the ‘grounded’ requirements from
potential system users. We believe that the proposed
ERMS can assist the emergency rescuers in
resolving the psychological problems effectively.
4 DISCUSSIONS
AND CONCLUSIONS
There is an increasing frequency of natural disasters
happening worldwide. Due to the high density of
population, especially in developing countries, such
incidents frequently result in great pressure on the
limited rescue resources. Suffering from enormous
emotional pressure, emergency rescuers may
develop serious psychological problems. Moreover,
the interviews conducted in this study revealed that
emergency rescuers are hoping for timely and
effective professional advices to ease their
psychological pressures. Consequently, we propose a
mobile ERMS to support emergency rescuers.
In order to optimize the value of ERMS, we have
followed the design science paradigm in the
Information Systems discipline in guiding the non-
linear and iterative processes of user requirements
elicitation, theory building, system artifact design
and development, which will be followed by field
testing in the next stage of the work. DSR is an
important paradigm in the Information Systems
discipline, it is essential for us to understand and
communicate the design science research process, as
it can establish the credibility of IS design science
research among the various fields. Following
Hevner’s three cycle view of design science research,
we took an innovative method in system
requirements elicitation, system design and feedback.
In the relevance cycle, we interviewed emergency
rescuers to explore the existing problems and system
requirements. In the rigor cycle, we reviewed a
series of empirical studies to find out design theories
that address the needs of emergency rescuers, and to
help with establishing the system design
requirements. In the design cycle, we discussed the
design process of ERMS, which caters for the design
theory reviewed in the rigor cycle and the emergency
rescuers’ actual demands as discussed in the
relevance cycle.
To conclude, this position paper describes a pilot
study exploring the key factors in the system design
that potentially influence the value of mobile ERMS.
This study gives interesting insights on the design
guidelines for the virtual advisory systems in the
mental health self-help area that may encourage
further interesting discussions among both
researchers and practitioners. For the next stage, we
will carry out a series of large scale experiments to
quantitatively examine the relationships between
different constructs of interest as proposed in the
rigor cycle, in order to refine our system design
artifact further and to contribute to the body of IS
HEALTHINF2014-InternationalConferenceonHealthInformatics
470
knowledge particularly in the area of human-
computer interaction theories.
ACKNOWLEDGEMENTS
This work was supported jointly by the National
Natural Science Foundation of China (Grant No.
71201021) and the Fundamental Research Funds for
the Central Universities (Grant No. N120404015).
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APPENDIX
Table 1: Exemplar empirical studies in the healthcare self-services area.
Source Context Functions Sense of Human Touch Accessibility Personalization Engagement Others
www.freemd.com
FreeMD
based on PC
·Present a variety of symptoms
by step-by-step guidance
·Generate a report about the
cause of symptoms.
·Help users determine the most
appreciate time and place to
receive healthcare.
+Interacting with both
voice and text
+The advisor appears in
the form of virtual human
+With the rich
expressions and actions
+With pictures to
elaborate the
questions
+Giving effective
advices
-Lengthy questions
+Tailored advice
for hospital
+Attractive
-Limited
functionality
+Fast
www.depression.edu.hk
Depressed
little prince
based on PC
·Learn some basic knowledge of
depression
· Check emotional health
·Share experiences and gain
insights from other users.
+A sense of affinity
-Lack of interactivity
+Helpful to the
depressed person
+Providing detailed
knowledge
+Providing
effective advices
according to the
users’ feedback
-Only fit for the
depressed person
+Attractive
+Easily to get
engaged in it
+
References
to relevant
institutions
for further
support
Mattila, Korhonen et al.
2010
Wellness
Diary (WD)
based on
the mobile
platform
· Record self-observations
related to health and behavior
· Automatically generate the
graphical feedback based on the
collected data
-Lack of human
interaction
+Simplicity
+Presenting the
information in the
form of graph
+Easy usage
independent of
location and time
-Lack of
personalization
and profiling
-Lack of dynamic
options
-Lack of
sense of
control and
challenge
+Fast
+Mobility
Milošević, Shrove et al.
2011
UAHealth
based on the
mobile
platform
·Communicate through some
sensors in the wireless
environment
·Monitor people’s physiological
signals
·These collected data can be
accessed by users and medical
professionals
-Lack of interactivity
+Presenting the
collected
physiological signals
with graph and table
-Lack of diagnose
after monitoring
user’s physiological
signals
+Working both
online and offline
-Not
attractive
-Limited
functionality
+Monitor
multiply
signals at a
time
Note: +: Advantages -: Disadvantage
Table 2: Key design principals for mobile ERMS from literature.
Study Construct
name
Definition Influence factors
(Xu and Chen, 2006)
Transparency
The extent to which the content is perceived by the
user as easy to read and understand.
·Background knowledge
·Presentation of the content
·Use of examples in explanation
·Inclusion of graphics
(Komiak and Benbasat,
2006)
Personalization
Perceived personalization is a customer’s perception
of an
RA’s personalization (i.e., the extent to which the RA
understands and represents his or her personal
needs).
·Identifying all product attributes important to that particular customer
·Capturing the relative importance among different product attributes
·Helping novice customers by mapping their shopping goals to product
attribute specifications
(Sidner et al., 2005) Engagement
Engagement is the process by which interactors start,
maintain and end their perceived connection to each
other during an interaction.
·Head gestures
·Facial gestures
·Hand gestures
·Body movements
·Similarity in communication style
(Gefen and Straub,
2003)
Social Presence/
Humanoid
Social presence refers to the extent to which an
artifact is perceived as sociable, warm, personal, or
intimate when interacting with it.
·Human or human-like elements appearing in virtual environments
·The use of expressive slang and humour
(Koufaris, 2002) Sense of Control
Sense of control has been defined as the level of one’s
control over the environment and one’s actions.
·Recommendation agents to enable customers to easily find what they need,
learn more about it and quickly purchase it
(Al-Natour et al., 2011) Trustworthiness
Trustworthiness is a belief that concerning the
experience of interacting with the artifact relative to
the utilitarian outcomes of that interaction, in regard
to achieving specific goals (e.g., the shopping assistant
is competent in choosing the right product).
·Internal similarity (intangible characteristics manifested through verbal
cues such as perceptions, attitudes, and values)
·The decision process similarity
·The personality similarity
(Mazzotta et al., 2007)
Perceived
Persuasiveness
Perceived persuasiveness refers to recommend the
desired behavior by influencing, at the same time, the
attitudes which may affect positively the intention to
conform to it.
·By influencing his values and goals
·By enhancing the perceived relevance of attitudes for behavioral changes.
·By strengthening the Recipient’s awareness of his ability to conform to the
desired behaviour.
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