Background Given their growing popularity, mobile health (mHealth) apps may offer a viable method of delivering psychological interventions for people with an atypical appearance (ie, visible difference) who struggle with appearance-related distress. Acceptance and Commitment Therapy (ACT), a third-wave cognitive behavioral approach, has been used effectively in mHealth and is being increasingly applied clinically to common psychosocial difficulties associated with visible differences. We planned to design an ACT-based mHealth intervention (ACT It Out) for this population. Objective The aim of this study is to gain key stakeholder input from user representatives and psychological clinicians to optimize the intervention’s design for future development and uptake. To do so, we explored considerations relating to mHealth as a delivery platform for adults with visible differences and elicited stakeholders’ design preferences and ideas based on initial author-created content. Methods Within a participatory design framework, we used a mix of qualitative methods, including usability sessions and a focus group in a face-to-face workshop, and interviews and textual feedback collected remotely, all analyzed using template analysis. A total of 6 user representatives and 8 clinicians were recruited for this study. Results Our findings suggest that there are likely to be strengths and challenges of mHealth as an intervention platform for the study population, with key concerns being user safeguarding and program adherence. Participants expressed design preferences toward relatable human content, interactive and actionable features, flexibility of use, accessibility, and engaging content. Conclusions The findings offer valuable design directions for ACT It Out and related interventions, emphasizing the need to carefully guide users through the intervention while acknowledging the limited time and space that mHealth affords.
Background Mobile apps may offer a valuable platform for delivering evidence-based psychological interventions for individuals with atypical appearances, or visible differences, who experience psychosocial appearance concerns such as appearance-based social anxiety and body dissatisfaction. Before this study, researchers and stakeholders collaboratively designed an app prototype based on acceptance and commitment therapy (ACT), an evidence-based form of cognitive behavioral therapy that uses strategies such as mindfulness, clarification of personal values, and value-based goal setting. The intervention also included social skills training, an established approach for increasing individuals’ confidence in managing social interactions, which evoke appearance-based anxiety for many. Objective In this study, the authors aim to evaluate the feasibility of an ACT-based app prototype via the primary objectives of user engagement and acceptability and the secondary feasibility objective of clinical safety and preliminary effectiveness. Methods To address the feasibility objectives, the authors used a single-group intervention design with mixed methods in a group of 36 participants who have a range of visible differences. The authors collected quantitative data via measures of program use, satisfaction ratings, and changes over 3 time points spanning 12 weeks in outcomes, including selected ACT process measures (experiential avoidance, cognitive defusion, and valued action), scales of appearance concerns (appearance-based life disengagement, appearance-fixing behaviors, appearance self-evaluation, and fear of negative appearance evaluation), and clinical well-being (depression and anxiety). Semistructured exit interviews with a subsample of 12 participants provided qualitative data to give a more in-depth understanding of participants’ views and experiences of the program. Results In terms of user engagement, adherence rates over 6 sessions aligned with the upper boundary of those reported across mobile mental health apps, with over one-third of participants completing all sessions over 12 weeks, during which a steady decline in adherence was observed. Time spent on sessions matched design intentions, and engagement frequencies highlighted semiregular mindfulness practice, mixed use of value-based goal setting, and high engagement with social skills training. The findings indicate a good overall level of program acceptability via satisfaction ratings, and qualitative interview findings offer positive feedback as well as valuable directions for revisions. Overall, testing for clinical safety and potential effectiveness showed encouraging changes over time, including favorable changes in appearance-related life disengagement, appearance-fixing behaviors, and selected ACT measures. No iatrogenic effects were indicated for depression or anxiety. Conclusions An ACT-based mobile program for individuals struggling with visible differences shows promising proof of concept in addressing appearance concerns, although further revisions and development are required before further development and more rigorous evaluation.
BACKGROUND Mobile apps may offer a valuable platform to deliver evidence-based psychological interventions for individuals with an atypical appearance, or visible difference, who experience psychosocial appearance concerns such as appearance-based social anxiety and body dissatisfaction. Prior to this study, researchers and stakeholders collaboratively designed an app prototype based on Acceptance and Commitment Therapy (ACT), an evidence-based form of cognitive behavioural therapy that utilises strategies such as mindfulness, clarification of personal values and value-based goal setting. The intervention also included social skills training, an established approach for increasing individuals’ confidence in managing social interactions which for many evoke appearance-based anxiety. OBJECTIVE In this study, the authors sought to evaluate the feasibility of an ACT-based app prototype via the primary objectives of user engagement and acceptability, and the secondary feasibility objective of clinical safety and preliminary effectiveness. METHODS To address the feasibility objectives, we employed a single group intervention design with mixed methods in a group of 36 participants who have a range of visible differences. The authors collected quantitative data via measures of program usage, satisfaction ratings, and changes over three timepoints spanning 12 weeks in outcomes including selected ACT process measures (experiential avoidance, cognitive defusion and valued action), scales of appearance concerns (appearance-based life disengagement, appearance-fixing behaviors, appearance self-evaluation and fear of negative appearance evaluation), and clinical wellbeing (depression and anxiety). Semi-structured exit interviews with a subsample of 12 participants provided qualitative data to give a more in-depth understanding of participants’ views and experiences of the program. RESULTS In terms of user engagement, adherence rates over six sessions aligned with the upper boundary of those reported across mobile mental health apps, with over a third of participants completing all sessions over 12 weeks during which a steady decline in adherence was observed. Time spent on sessions matched design intentions, and engagement frequencies highlighted semi-regular mindfulness practice, mixed use of value-based goal-setting and high engagement with social skills training. Findings indicate a good overall level of program acceptability via satisfaction ratings, and qualitative interview findings offer positive feedback as well as valuable directions for revisions. Overall, testing for clinical safety and potential effectiveness showed encouraging changes over time, including favorable changes in appearance-related life disengagement, appearance-fixing behaviors and selected ACT measures. No iatrogenic effects in depression or anxiety were indicated. CONCLUSIONS An ACT-based mobile program for individuals struggling with visible differences shows promising proof-of-concept in addressing appearance concerns, while further revisions and development are required prior to further development and more rigorous evaluation.
BACKGROUND Given their growing popularity, mobile health apps (mHealth) may offer a viable method of delivering psychological intervention for people who have an atypical appearance (visible difference) and struggle with appearance-related distress. Acceptance and Commitment Therapy (ACT), a third-wave cognitive-behavioural approach, has been used effectively in mHealth and is being increasingly applied clinically to common psychosocial difficulties associated with visible difference. We planned to design an ACT-based mHealth intervention for this group. OBJECTIVE The authors sought to gain key stakeholder input from user representatives and psychological clinicians to optimise the intervention’s design for future development and uptake. METHODS Within a participatory design framework, we used a mix of qualitative methods including usability sessions and a focus group in a face-to-face workshop, and interviews and textual feedback collected remotely, all of which the authors analysed using template analysis. RESULTS The combined findings suggest strengths and challenges of mHealth as an intervention platform for the population, including considerations regarding safeguarding and users’ ongoing engagement. Participants expressed design preferences towards relatable human content, interactive and actionable features, flexibility of use and accessible, engaging content. CONCLUSIONS Findings offer valuable design directions for ACT It Out and other related interventions, emphasising the need to carefully guide users through the intervention while acknowledging the limited time and space afforded by mHealth as a platform.
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