Exploring caregiver experiences with the altitudes digital mental health program: A thematic analysis

Abstract

Objective

Caregivers play an important role in the recovery of young people experiencing early psychosis, though they often experience high distress and have limited access to support for their own wellbeing and mental health needs. Digital mental health interventions (DMHIs) such as Altitudes offer scalable and flexible support through the provision of psychoeducation, therapy content, and opportunities for social connection in a secure online platform. The objective of this study was to explore caregivers’ subjective experiences using Altitudes, a digital mental health intervention designed to support the wellbeing of caregivers of young people experiencing early psychosis.

Methods

Semi-structured interviews were conducted with 21 caregivers who participated in a 6-month open trial of Altitudes in the United States. A reflexive thematic analysis was used to examine perceived benefits, challenges, and recommendations for improvement.

Results

Four themes were identified: (1) Altitudes as a trusted resource in a confusing journey, reflecting caregivers’ appreciation for clear, credible information and normalization through peer connection; (2) The importance of human support, emphasizing the role of Clinical Moderators and Family Peer Workers as sources of empathy, accountability, and hope in the digital space; (3) Striking a balance and overcoming barriers to engagement, highlighting how caregiving demands and illness phase shaped participation and preferences for support; and (4) Recommendations for future development, including requests for more interactive features, notifications and reminders, and opportunities for live or in-person connection.

Conclusions

Participants viewed Altitudes as a caregiver-focused resource that reduced isolation and stigma, and improved access to credible psychosis-specific information and therapy strategies. Embedding human-supported DMHIs within coordinated specialty care may strengthen continuity of care and improve outcomes for both caregivers and young people early in the course of psychotic illness.

Introduction

Schizophrenia spectrum disorders constitute a major public health burden with profound personal, familial, and societal consequences. The lifetime prevalence of psychotic disorders is approximately 3% of the population, with onset most commonly occurring between the late teens and early 30s.^1,2 In the United States alone, the economic cost of schizophrenia is estimated to be approximately $367 billion annually. ³ This burden extends well beyond direct health care expenditures and includes indirect costs from lost productivity, premature mortality, and substantial impacts on family members who provide care for the young person experiencing early psychosis. ³ Together, this highlights the far-reaching and multi-dimensional effects of psychotic disorders on individuals, families, and systems of care.

Family members serve an important role in the care and recovery following an initial psychotic episode. Caregivers often provide substantial emotional, practical, and financial support to their affected relative.^4,5 On one hand, many supporters report positive experiences related to caregiving, including increased family closeness, learning new coping strategies and advocacy skills, and greater compassion for others facing mental health challenges.^6,7 On the other hand, psychosis caregiving is often associated with considerable burden, including elevated stress, internalizing symptoms, and reduced quality of life.^7–9

Although families are central to the Coordinated Specialty Care (CSC) model and are engaged through interventions such as family education, multifamily group, and individual family therapy, the specific needs of caregivers themselves are not consistently prioritized or systematically integrated into treatment.^10–13 When available, caregiver-focused interventions are often limited, resource-intensive, clinic-based, and oriented primarily toward supporting the patient rather than addressing the caregiver’s own wellbeing.^14–16 Digital mental health interventions (DMHIs) can address these limitations by providing caregiver support that is more scalable, adaptable, accessible, and affordable than traditional services.

Beyond expanding access and compensating for the constraints of in-person care, systematic reviews demonstrate that digital supports can facilitate interactive, real-time communication, mitigate the impact of stigma on help-seeking, and deliver timely resources that may reduce unnecessary clinical visits and hospitalizations.^17,18 A small but growing body of research further suggests that digital platforms can increase knowledge, enhance coping skills, and reduce distress among family members.^17,19–23

Even fewer studies have captured caregivers’ perspectives on the acceptability and impact of digital interventions designed to provide mental health support and deliver therapy skills for FEP families. To address this gap, we conducted semi-structured qualitative interviews with parents who engaged in an open trial of Altitudes in the United States. ²³ Altitudes is a Moderated Online Social Therapy (MOST) platform that offers continuous access to psychoeducational and therapeutic resources as well as opportunities to connect with other caregivers, family peer support workers, and clinicians.^24,25 See this tutorial for a visual overview of the platform.

This study aims to understand the individual experiences of primary caregivers of young adults with FEP who engaged with a multifaceted digital intervention specifically designed to support their needs. We explored caregivers’ patterns and experiences using the platform, what they found helpful or challenging, and their recommendations for improving the Altitudes program. By highlighting both strengths and limitations through the caregiver lens, this work aims to advance our understanding of how thoughtfully designed digital tools can strengthen caregiver wellbeing and equip families to deliver the sustained support essential for young people’s long-term recovery from psychosis.

Methods

Study design

This study followed a qualitative design to explore caregivers’ experiences with the Altitudes digital intervention. The study design, materials, and procedure were approved by the Institutional Review Board at the University of North Carolina at Chapel Hill (IRB #23-1676). The study was conducted as a rolling six-month open trial between January and November 2024. Caregivers were recruited using convenience sampling from CSC programs in Chapel Hill and Wilmington, North Carolina. These programs serve broad regional catchment areas, with some families accessing services from more distant communities across the state (e.g., Fayetteville).

Participants

Recruitment occurred through referrals from treatment teams and self-referral in response to study flyers posted in clinic offices. Eligible participants were adults (≥18 years) who identified as unpaid caregivers of a young person with early psychosis (illness onset ≤5 years) enrolled in CSC treatment. Exclusion criteria included lack of English proficiency, no internet access, involvement in legal action against the relative with FEP, or unwillingness to be audio recorded. All caregivers enrolled in the open trial were invited to provide feedback regardless of their level of engagement in Altitudes.

Intervention

Altitudes is an updated adaptation of the MOST platform originally evaluated in Australia^20,21 and redesigned with interactive, caregiver-focused therapy content to support relatives of young people experiencing FEP in the United States. ²³ The platform includes a “Community” page with social networking features (e.g., peer connection, posting, collaborative problem-solving), multi-media therapy resources (e.g., voice-guided mindfulness and self-compassion exercises), and psychoeducational materials tailored to caregivers (e.g., infographics on the stress-vulnerability model, guidance on recognizing early warning signs of relapse).

Human support for the digital intervention was provided by Clinical Moderators and Family Workers. Clinical moderators conducted brief check-in calls every 2-4 weeks to support engagement with platform content. Moderators included graduate students in social work or psychology, a provisionally licensed mental health counselor, and a licensed clinical psychologist. Although clinical moderators had psychotherapy training and experience, these calls were intended to orient participants to the platform and support engagement (e.g., troubleshooting access issues and encouraging use of therapy content) rather than provide one-on-one therapy. Family Workers, caregivers with lived experience and training in digital peer support, sent welcome messages to new users, posted content on the Community page, and facilitated monthly virtual process groups.

Procedure

Participants provided written informed consent prior to study initiation and before completing any study procedures. Recruitment, screening, assessments, interviews, demographic questionnaires, and orientation to the Altitudes program were conducted remotely by clinical research staff at the University of North Carolina. After being given access to the platform for six months, caregivers were invited to participate in semi-structured individual interviews conducted via secure videoconferencing. Interviews explored experiences with Altitudes, including barriers, facilitators, perceptions, and recommendations for improvement (see Supplement 1 for the interview guide). Two female master’s level coordinators (EF, HC) conducted all interviews via HIPAA-compliant Zoom between July and October 2024. Both had prior contact with participants through research assessment visits and were trained in qualitative interviewing. Caregivers were informed that their feedback would help refine Altitudes for future use in NC CSC programs.

Statistical analysis

Descriptive statistics were used to summarize participant demographic characteristics of the sample and contextualize the qualitative findings.

Interviews were audio recorded, de-identified during transcription, and analyzed using a mixed inductive-deductive approach. We followed Maguire and Delahunt’s step-by-step guide to thematic analysis. ²⁶ Study coordinators (EF, HC) analyzed a randomly selected subset of transcripts to develop an initial codebook with descriptions of each theme and definitions of preliminary codes. After reviewing all interviews and transcripts, the lead author (KL) refined the codebook and developed rules for application (see Supplement 2 for the final codebook).

The coding team comprised a licensed clinical psychologist (KL), a study coordinator (HC), and three undergraduate research assistants who also transcribed each interview (HD, JL, RS). Training began with an orientation to thematic analysis and the Altitudes program, along with instruction on applying codes in Dedoose qualitative analysis software. ²⁷ The team then practiced line-by-line coding on select transcripts, collaboratively discussing areas of disagreement to reach consensus, and iteratively refining the codebook across four training meetings in January 2025.

During analysis, each transcript was independently coded by two team members and reviewed by a third consensus coder (KL or HC). From February to April 2025, the team met weekly to resolve discrepancies, update the codebook, and refine emerging themes. Coders applied the finalized codebook to all transcripts, discussing and resolving discrepancies to reach consensus. This process continued until all interviews had been coded, and thematic saturation was achieved. Throughout the process, the team engaged in reflexive discussions to examine potential biases stemming from their personal, clinical, and research backgrounds. All members of the coding team were female, had completed at least some college education, and identified as White (67%) or Asian (33%). Demographic information of the researchers and assistants involved in coding is provided to promote transparency regarding the perspectives represented.

Results

Among 24 eligible caregivers, 21 (87.5%) completed an interview. One caregiver never logged into the platform and declined participation due to lack of experience, one declined because they did not want to be audio recorded, and one was lost to follow-up. Interview length ranged from 19 to 73 minutes, with a mean duration of 40.5 minutes (SD = 13.6). Sample characteristics are presented in Table 1.

Table 1.

Demographic and characteristic information of caregivers.

Characteristic	N = 21
	M	SD
Age (years)	57.5	8.7
​	n	%
Gender
Female	15	71.4
Male	5	23.8
Transgender Female	1	4.8
Race
Caucasian	18	85.7
Black	1	4.8
Asian	2	9.5
Ethnicity
Hispanic	2	9.5
Not Hispanic	18	85.7
Prefer not to answer	1	4.8
Education Level
High school or equivalent	1	4.8
Some college	4	19.0
College degree	9	42.9
Higher than college	7	33.3
Employment Status
Unemployed	3	14.3
Part-time	3	14.3
Full-time	12	57.1
Retired	3	14.3
Living with loved one
Yes	16	76.2
No	5	23.8
Phase in loved one’s recovery
Prodrome	1	4.8
Acute	2	9.5
Initial stabilization	7	33.3
Consolidating gains	8	38.1
Prolonged recovery	3	14.3

Analysis of caregiver interviews generated several themes reflecting how families experienced the Altitudes program. Themes centered on perceptions of Altitudes as a resource, the human support elements of the program, personal and contextual factors that affected engagement, perceived benefits and limitations of platform features, and recommended modifications for future implementations in NC CSC programs.

Altitudes as a trusted resource in a confusing journey

Most caregivers described Altitudes as a valuable source of information, skills, and connection. Seventeen participants explicitly endorsed the program as helpful, highlighting the clarity and trustworthiness of the content:

When you go out on the internet to try to find some information about psychosis, you just get a lot… you have to worry about is this a reputable source or not? I felt that at least the learning templates were straight to the point about psychosis and not all the other stuff… it was just nice that it related to the journey of psychosis. (P18)

Eighteen caregivers emphasized the Community page as a central and valued feature. Many described it as a safe space to exchange encouragement and advice, where reading others’ stories provided reassurance and normalized their experiences:

It helps you feel like you're not the only one… To me, it was just support that regardless of what was being said, I knew everyone was there for the same reason, and we all love our people and just want help for them. (P04)

Several participants also noted that exposure to other caregivers’ stories fostered hope and helped counteract stigma.

The power of human support: Clinical moderators and family peer workers

Seventeen caregivers described clinical moderators as a consistent source of guidance, support, and encouragement. They valued the flexibility, empathy, accountability, and individualized resources the moderators provided:

I absolutely loved [clinical moderator]. She was not judgmental, and she was very empathetic, would listen, had resources but not in a way of trying to fix my problems if that makes any sense. Yea, so, I think having that human touch made it obviously much better than just going on to the platform. And yes, there was human touch onto the platform with the community but having others associated with it like the meetings and you know her calls makes it even more impactful plus she would be like ‘Hey have you done it yet?’ (P01)

Family peer support workers were also described as beneficial, though discussed less frequently. Caregivers appreciated their authenticity and relatability, noting that peers could speak more plainly than clinicians and instilled hope:

One of the family workers was very plain spoken and shared ‘this is what you need to do.’ I needed that… She was so helpful to me. (P16)

Striking a balance and overcoming barriers to engagement

Patterns of engagement varied widely. Some caregivers logged in regularly, while others described inconsistent use shaped by life circumstances. Fourteen participants shared that work, family responsibilities, or competing priorities served as barriers to engagement. Six described active avoidance, noting that the program could trigger distress by reminding them of the “dark days” of their relative’s illness. Some commented that they engaged less when their loved one was doing well, while many emphasized the program would have been especially valuable during the acute or “early days” of illness:

I wish I would have had it when my loved one was in a crisis or immediately after. (P09)

We really needed this probably three years ago… when we were totally clueless about everything. (P03)

Perceptions of synchronous interactions on the platform varied. While some caregivers wished for more frequent posts, others felt the level of communication was sufficient. Seven people specifically requested additional opportunities for live or in-person interaction with other parents, noting that asynchronous communication alone could not fully address their social or emotional needs. For example, one parent shared:

I'm not a fan of online interaction in general. Um never have been. I'm an introvert by nature anyways, and um. But in person things for me are much more, well I'm just much more connected. (P09)

Others suggested expanding the platform to include supporters beyond primary caregivers (e.g., siblings, partners, friends, extended relatives) who were part of the support system. Despite these differences, most regarded it as a unique and supportive space not available in traditional services for FEP families.

Also, gearing the focus of Altitudes towards the caregivers because we are so consumed with our loved one’s care. So, you know in [multifamily] group, it’s more you know focused on the person going through the psychosis, right. But you know Altitudes is, it really tries to I’ve noticed it’s for [us] you know, and so. I think that’s a good focus point. Like when I go on Altitudes, I’m reminded okay this is about me more so than it is about my son, right, so I like that because without that you just get consumed with you know your loved one. (P18)

Recommendations for future development of altitudes

Caregivers offered a variety of suggestions to improve Altitudes. Nineteen participants described the platform as easy to use and navigate. However, some suggested adding multimedia content (e.g., videos) or tailoring content more flexibly to their needs. As one parent suggested:

Maybe make it a little snazzier. A little more maybe video or you know just jazz it up a little bit. It was, you know, pretty nicely designed but not snazzy l guess. (P21)

Ten participants recommended reminders or notifications to encourage consistent engagement. Others requested adding more caregiver stories, increasing emphasis on the structural complexities of the US healthcare system that leave families feeling lost when seeking care for a young person with psychosis, and providing streamlined ways to access local resources.

Several caregivers highlighted the need for more individualized supports, including access to one-on-one therapy or counseling specifically for caregivers:

I've contacted [clinic] too looking for people to help us find a therapist just in dealing with, you know, the future because this is going to be a lifetime thing. And it's big, it's a big change for us as caregivers. It's not where we expected to be and we're really dealing with that right now and I think having someone to talk to about that would be really helpful… I don't know but that would be good, having that one-on-one contact more would be helpful. (P06)

Taken together, these findings illustrate that while caregivers valued Altitudes as a trusted, caregiver-focused resource, their recommendations underscore the importance of expanding supports beyond the platform to address unmet needs and strengthen the continuum of care for families navigating psychosis.

Discussion

This study contributes to the growing body of literature on DMHIs for caregivers of young people early in the course of psychotic illness. Findings emphasize the centrality of social connection and shared lived experience in reducing stigma, enhancing wellbeing, and sustaining care for their affected relative. Importantly, the results underscore the value of incorporating human support elements such as clinicians, family peer support workers, and a community of FEP family members, to augment the impact of digital resources. The creation of a secure, private, and accessible online environment appeared to promote a sense of reassurance, normalization, and empowerment among caregivers.

Consistent with prior qualitative research, caregivers reported that the value of Altitudes extended beyond psychoeducation and therapy content. The Community page was described as a safe, stigma-reducing space that reduced isolation and loneliness accompanying the caregiving role and reinforced a sense of shared lived experience. These observations align with the cognitive model of caregiving in psychosis, which posits that appraisals of burden can be mitigated by positive coping resources such as social support and hopeful reminders that recovery is possible. ⁷

In practice, the human support components allowed the program to be individualized and flexibly adapted for each user. Moderators could respond to emergent caregiver needs (e.g., requests for information on new psychotropic medications) and direct families to relevant therapy content. This responsiveness positioned Altitudes not as a static repository of information but as a flexible, person-centered intervention. Such findings reinforce emerging evidence suggesting that incorporating human support elements offers greater ecological validity and clinical benefit than self-guided digital tools alone. ²⁸ At the same time, there is an inherent trade-off between the benefits of individualized, human-supported interventions and the challenges such approaches pose for scalability and resource allocation. ²⁹

Although nascent and not without risks, there may be potential for artificial intelligence to reduce the impact of this trade-off. For example, Palmer et al. ³⁰ evaluated a digital intervention for anxiety that combined an AI-driven conversational agent with human support. This study demonstrated preliminary clinical benefits of generative AI were comparable to cognitive behavioral therapy with a human therapist but required substantially less of the clinician’s time (less than two hours across a 16-session treatment). At present, there are no plans to incorporate chatbots or other AI-driven features into the Altitudes platform. Rather, this example highlights how future DMHIs may explore ways to preserve individualized responsiveness while maintaining reach and scalability. However, the use of AI in mental health interventions raises important ethical and safety considerations, particularly when supporting caregivers experiencing significant stress. Any future integration of such technologies would require careful evaluation to ensure intervention quality, safety, and appropriate human oversight.

Caregivers’ engagement with Altitudes was variable, reflecting both the episodic course of psychosis and changes in family functioning and illness appraisals over time. ³¹ Some caregivers reported engaging most actively during periods of stability, when they had the capacity to reflect and learn, whereas others described turning to the platform more often during times of distress. Several also described intentional periods of non-use, either due to competing demands or a desire to temporarily disengage from psychosis-related content. Such variability is consistent with broader DMHI research documenting diverse and fluctuating patterns of participation. ²⁹ Current findings suggest that lower levels of activity should not necessarily be interpreted as disengagement but may instead reflect shifting psychosocial needs over time.

Furthermore, rather than assuming a single optimal level of engagement, platform use will likely vary according to caregiver characteristics and contextual factors. Some caregivers may seek social connection within a private community of individuals with shared lived experience, whereas others may primarily engage with informational or therapeutic content. Caregivers’ needs may also shift across stages of their relative’s recovery. Accordingly, the goal of engagement is not constant or high-frequency use but timely access to support, information, and coping strategies when these resources are most needed. DMHIs should therefore anticipate fluctuations in participation and be designed to support flexible, “as-needed” engagement. Human support, personalized prompts, and other adaptive design features may help facilitate re-engagement during periods when additional support may be needed. ³²

Importantly, not all caregivers require or desire digital support. Some may benefit more from individual therapy focused on their own mental health needs and the development of specific caregiving skills, such as adjusting illness perceptions and expectations of their relative, improving emotion regulation, and establishing healthy boundaries. ⁷ Some family members may be particularly drawn to one-on-one or small group formats that provide opportunities for deeper connection with other caregivers or in-person community-based activities. Others may prefer the flexibility, privacy, and accessibility afforded by digital options, which can deliver timely psychoeducation and ongoing peer connection without the logistical barriers of in-person participation. ²³ This complements research demonstrating that brief, needs-led intervention for early psychosis caregivers can be acceptable and effective in reducing caregiver distress. ³³

DMHIs such as Altitudes should be embedded within a broader continuum of care, providing flexible modalities that are consistent with caregiver preferences and responsive to system-level constraints. Such tailoring reduces the risk of marginalizing caregivers’ own mental health needs and ensures that services remain responsive across the caregiving trajectory. Importantly, this continuum should include access to crisis and emergency resources, particularly during the early stages of illness when youth are at increased risk of self-harm and suicide. ³⁴ Potential approaches include crisis or warm lines staffed by individuals trained in early psychosis care, which caregivers have identified as an unmet need for timely reassurance and guidance during moments of crisis. ²³ Other models include programs that embed trained family peer workers or liaisons within high-contact settings such as emergency departments or inpatient units (e.g., the Family Bridger model) to support caregivers during acute care encounters. ³⁵ Expanding the reach of DMHIs designed for caregivers of individuals with psychosis such as Altitudes or Bolster ³⁶ may also help provide accessible support during periods of heightened stress.

Diversity considerations are particularly important in interpreting these findings and ensuring that caregiver interventions do not inadvertently reinforce existing disparities. Our sample was predominantly white, female, and composed of biological or adoptive parents whose relatives were connected to specialized FEP services. The fact that women were overrepresented in our sample is a limitation of the study. However, this pattern is consistent with prior research and may reflect broader trends in the gender distribution of caregiving roles.^37,38 While interventions must continue to support women balancing caregiving with other responsibilities, they should also prioritize active engagement of fathers, siblings, partners, and extended relatives, who are also significantly affected by the onset of psychosis but remain underrepresented in research and treatment.^39,40

In contrast, families from lower socioeconomic and marginalized backgrounds were underrepresented in this study, despite evidence that these groups often face significant barriers to accessing and engaging in care. Disparities in treatment access and quality, experiences of discrimination and racism, as well as digital exclusion (i.e., lower digital literacy and access to technology) may compound these challenges. ⁴¹ Implementing DMHIs and other services to promote caregiver health and wellbeing would benefit from an increased focus on promoting equity and inclusion. Potential approaches include proactive outreach, culturally responsive programming, and partnerships with community organizations serving under-resourced populations. ⁴² Addressing workforce diversity and reducing structural barriers to entering CSC programs may also be important, as access to specialized early psychosis services remain an important upstream determinant of who can access caregiver interventions.

As with most qualitative research, these findings are context-bound, reflecting the specific setting, individuals, and circumstances in which the study was conducted. The interview guide was not formally validated or pilot tested prior to use, which may have introduced variability in how questions were interpreted and may limit the reproducibility of the data collected. The interviews capture the experiences of caregivers connected to CSC programs of small cities in North Carolina and therefore, should not be assumed to apply to all families supporting a relative experiencing early psychosis. Caregivers from different sociocultural or linguistic backgrounds, individuals living in rural or under-resourced areas, caregivers who were never referred or declined participation, or those supporting a young person unable or unwilling to access specialized services may hold perspectives and recommendations that differ from those included in this study. Future research should broaden representation to include caregivers of more diverse backgrounds, including but not limited to gender, race and ethnicity, socioeconomic status, and geographic location.

In addition, studies examining the scalability of blended models that balance personalization with reach, including hybrid approaches that integrate human support with adaptive technologies such as artificial intelligence, may be warranted. ³⁰ Future research should also examine patterns of engagement with digital caregiver platforms over time and identify individual and contextual factors associated with different trajectories of use. Evaluating the scalability of platforms such as Altitudes will likely require pragmatic implementation or hybrid effectiveness-implementation studies examining reach, adoption, feasibility, and sustainability when integrated into routine care pathways (e.g., CSC programs, youth mental health services, and acute care settings). ⁴³ Encouragingly, the MOST platform has already been implemented at scale within Australian youth mental health services, providing a model for how blended digital interventions can be integrated into routine care. ⁴⁴ Finally, disseminating a standardized needs assessment across a broader network of CSC programs could help clarify the extent to which families are interested in diverse forms of support, including individual therapy for caregivers, family peer support services, digital tools, and connections to spiritual, cultural, or community resources that promote social connection and wellbeing.

Conclusion

This study provides insights into caregivers’ subjective experiences using Altitudes, a human-supported digital mental health intervention designed to support family members of young people experiencing early psychosis. Caregiver feedback on the intervention highlighted the value of accessible psychoeducation, opportunities to connect and exchange resources with other early psychosis caregivers, and supportive outreach from empathic clinical moderators. When integrated within early psychosis services, human-supported digital platforms such as Altitudes may offer a scalable approach to expanding caregiver support in the United States.

Supplemental material

Supplemental material - Exploring caregiver experiences with the altitudes digital mental health program: A thematic analysis

Supplemental material for Exploring caregiver experiences with the altitudes digital mental health program: A thematic analysis by Kelsey Ludwig, Elizabeth Fraser, David Penn, Bryan Stiles, Hanna Campbell, Heidi Dittus, Rathisree Seenivasan, Jeongwoo Lee, Mario Alvarez-Jimenez and John Gleeson in Digital Health.

Supplemental material

Supplemental material - Exploring caregiver experiences with the altitudes digital mental health program: A thematic analysis

Supplemental material for Exploring caregiver experiences with the altitudes digital mental health program: A thematic analysis by Kelsey Ludwig, Elizabeth Fraser, David Penn, Bryan Stiles, Hanna Campbell, Heidi Dittus, Rathisree Seenivasan, Jeongwoo Lee, Mario Alvarez-Jimenez and John Gleeson in Digital Health.