BACKGROUND:Remote measurement technologies (RMTs) have the potential to revolutionize major depressive disorder (MDD) disease management by offering the ability to assess, monitor, and predict symptom changes. However, the promise of RMT data depends heavily on sustained user engagement over extended periods. In this paper, we report a longitudinal qualitative study of the subjective experience of people with MDD engaging with RMTs to provide insight into system usability and user experience and to provide the basis for future promotion of RMT use in research and clinical practice.OBJECTIVE:We aimed to understand the subjective experience of long-term engagement with RMTs using qualitative data collected in a longitudinal study of RMTs for monitoring MDD. The objectives were to explore the key themes associated with long-term RMT use and to identify recommendations for future system engagement.METHODS:In this multisite, longitudinal qualitative research study, 124 semistructured interviews were conducted with 99 participants across the United Kingdom, Spain, and the Netherlands at 3-month, 12-month, and 24-month time points during a study exploring RMT use (the Remote Assessment of Disease and Relapse-Major Depressive Disorder study). Data were analyzed using thematic analysis, and interviews were audio recorded, transcribed, and coded in the native language, with the resulting quotes translated into English.RESULTS:There were 5 main themes regarding the subjective experience of long-term RMT use: research-related factors, the utility of RMTs for self-management, technology-related factors, clinical factors, and system amendments and additions.CONCLUSIONS:The subjective experience of long-term RMT use can be considered from 2 main perspectives: experiential factors (how participants construct their experience of engaging with RMTs) and system-related factors (direct engagement with the technologies). A set of recommendations based on these strands are proposed for both future research and the real-world implementation of RMTs into clinical practice. Future exploration of experiential engagement with RMTs will be key to the successful use of RMTs in clinical care.

Attention-deficit hyperactivity disorder (ADHD) affects around 5% of children and adults worldwide (Polanczyk et al., 2015; Simon et al., 2009) and is characterised by inattention, impulsivity and hyperactivity (American Psychiatric Association, 2000). Having ADHD incurs greater risk of learning, behavioural and emotional problems, poorer educational outcomes, lower occupational status and relationship problems (Faraone et al., 2000). Psychostimulants (e.g. amphetamine and methylphenidate) are the most effective treatments available for all ages and the first line treatment for adults. They reduce symptoms in around 80% of patients (Barkley et al., 1991; Dittmann et al., 2014; Milich et al., 2001). However, whilst they can be effective, many experience residual symptoms (Dittmann et al., 2014) or significant side effects (Mariani et al., 2007), and there are concerns that the drugs may be abused (Darredeau et al., 2007; Laviola et al., 1999; Schenk & Davidson, 1998). Non-stimulant treatments exist, but the response rate is lower (Dittmann et al., 2014), and many still experience side effects (Mariani et al., 2007). Given the limitations of the available medications, other therapeutic approaches are being considered. Exercise has been shown to improve symptoms and cognitive functioning in children with ADHD (Chang et al., 2012; Jensen & Kenny, 2004; Piepmeier et al., 2015) and may also be beneficial for adults (Abramovitch et al., 2013). Exercise within the context of ADHD has been the focus of several systematic reviews and meta-analyses in recent years, all of which have found exercise to offer some functional improvement (Cerrillo-Urbina et al., 2015; Neudecker et al., 2019; Suarez-Manzano et al., 2018; Vysniauske et al., 2016). The exact mechanism by which exercise might alleviate ADHD symptoms is unknown, but both exercise and psychostimulants act on dopamine and BDNF suggesting there may be shared mechanisms (Archer & Kostrzewa, 2012; Ji et al., 2014; Kim et al., 2011; Kuczenski & Segal, 1997, 2002; Powers, 2000). As indicated above, one of the concerns about psychostimulant medication is its risk of abuse. Indeed ADHD is often