A Solution-Focused Research Approach to Achieve an Implementable Revolution in Digital Mental Health

Mohr, David C.; Riper, Heleen; Schueller, Stephen M.

doi:10.1001/jamapsychiatry.2017.3838

Cited by 153 publications

(117 citation statements)

References 7 publications

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“…The use of personalisation, ambient information and visual metaphors provided a step change in therapy delivery to assist learning, monitoring and management [36][37]. The application of inclusive UCD to the therapy interface may improve adherence, thereby increasing the likelihood of delivering benefit in real-world settings [64].…”

Section: Discussionmentioning

confidence: 99%

How Inclusive, User-Centered Design Research Can Improve Psychological Therapies for Psychosis: Development of SlowMo

Hardy¹,

Wojdecka²,

West³

et al. 2018

JMIR Ment Health

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Background Real-world implementation of psychological interventions for psychosis is poor.Barriers include therapy being insufficiently usable and useful for a diverse range of people.User-centred, inclusive design approaches could improve the usability of therapy, which may increase uptake, adherence and effectiveness.Objective To optimise the usability of an existing psychological intervention, Thinking Well, which targets reasoning processes in paranoia using a basic digital interface.Methods We conducted inclusive, user-centred design research characterised by purposive sampling of 'extreme' users from the margins of groups, ethnographic investigation of the problem context, and iterative prototyping of solutions. The UK Design Council's Double Diamond method was used. This consisted of 4 phases: discover, including a case series of Thinking Well, stakeholder interviews, desk research, user profiling, system mapping and a mood board; define, consisting of workshops to synthesise findings and generate the design brief; develop, involving concept workshops and prototype testing; and deliver, in which the final minimal viable product was storyboarded and iteratively coded.Results Consistent with our previous work, the Thinking Well case series showed medium/large effects on paranoia and wellbeing, and small effects on reasoning. These were maintained at follow-up despite some participants reporting difficulties with the therapy interface. Insights from the discover phase confirmed that usability was challenged by information complexity and poor accessibility. Participants were generally positive about the potential of technology to be enjoyable, help manage paranoia and provide tailored interpersonal support from therapists and peers, although reported privacy and security concerns. The define phase highlighted that the therapy redesign should support monitoring, simplify information processing, enhance enjoyment and trust, promote personalisation and normalisation, and offer flexible interpersonal support. During the develop phase over 60 concepts were created, with two key concepts of thoughts visualised as bubbles, and therapy as a journey selected for storyboarding. The output of the deliver phase was a minimal viable product of an innovative digital therapy, SlowMo. SlowMo works by helping people to notice their worries and fast thinking habits, and encourages them to slow down for a moment to find ways of feeling safer. A webapp supports the delivery of eight face-to-face sessions, which are synchronised to a native mobile app.Conclusions SlowMo makes use of personalisation, ambient information and visual metaphors to tailor the appeal, engagement and memorability of therapy to a diversity of needs. Feasibility testing has been promising, and the efficacy of SlowMo therapy is now being tested in a multi-centred randomised controlled trial. The study demonstrates that developments in psychological theory and techniques can be enhanced by improving the usability of the therapy interface in order to ...

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Section: Discussionmentioning

confidence: 99%

How Inclusive, User-Centered Design Research Can Improve Psychological Therapies for Psychosis: Development of SlowMo

Hardy¹,

Wojdecka²,

West³

et al. 2018

JMIR Ment Health

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“…However, the poor adoption of eMHS worldwide indicates that low acceptability and intention to use might constitute a barrier in reaching the full potential of internetbased approaches (cf. [28][29][30][31][32].…”

Section: Introductionmentioning

confidence: 99%

Public Attitudes Toward Guided Internet-Based Therapies: Web-Based Survey Study (Preprint)

Apolinário-Hagen¹,

Harrer²,

Kählke³

et al. 2018

Preprint

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Background: Internet interventions have been proposed to improve the accessibility and utilization of evidence-based psychological treatments. However, little is known about attitudes toward such treatments, which can be an important barrier to their utilization. Objective: This study aimed to (1) determine attitudes toward guided internet interventions, to (2) assess its acceptability compared to other internet-based formats, and to (3) explore predictors of acceptance. Methods: A web-based survey (N=646) assessed attitudes toward guided internet therapies (i.e. "perceived usefulness/helpfulness", "relative advantage compared to face-to face therapy"), preferences for delivery modes ("e-preference": guided Internet interventions, unguided internet interventions, video conferencing psychotherapy (VCP)) as well as potential predictors of attitudes and preferences, including socio-demographics, help seeking-related variables, attachment style, perceived stress. Results: Although most participants perceived internet interventions as useful or helpful (65.9%, 426/646), the minority indicated their relative advantage compared to face-to-face therapy (8.7%, 56/646). Most participants preferred guided internet interventions (39.0%, 252/646) over VCP (22.8%, 147/646), unguided internet interventions (19.2%, 124/646) and not using internet interventions (18.8%, 121/646; missing: 0.2%). Attachment avoidance and stress were related to epreference (all P<.05). Moreover, preference for therapist-guided internet interventions was higher for individuals aware of internet-based treatment (χ

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“…The majority of these tools are stand-alone, patient-facing self-help applications that have not been subject to any evaluation or regulation. Research has demonstrated that very few people sustain use of such self-guided interventions [3][4][5][6][7], which has prompted clinical investigators to explore new models of technology-supported care [5,[8][9][10]. Efforts to incorporate mobile tools into clinical care delivery and integrate patient-generated data into care processes are emerging.…”

Section: Introductionmentioning

confidence: 99%

“…Efforts to incorporate mobile tools into clinical care delivery and integrate patient-generated data into care processes are emerging. However, there is little research to guide these efforts, and few existing tools have demonstrated the capacity to link patients and providers directly [10][11][12]. Early experience suggests incorporating new health information technology tools into clinical practice is potentially disruptive because it directly impacts providers' task behaviors and requires them to alter routines [13,14].…”

Section: Introductionmentioning

confidence: 99%

Applying the Principles for Digital Development: Case Study of a Smartphone App to Support Collaborative Care for Rural Patients With Posttraumatic Stress Disorder or Bipolar Disorder (Preprint)

Bauer¹,

Hodsdon²,

Bechtel³

et al. 2018

Preprint

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Background: Despite a proliferation of patient-facing mobile apps for mental disorders, there is little literature guiding efforts to incorporate mobile tools into clinical care delivery and integrate patient-generated data into care processes for patients with complex psychiatric disorders. Objective: We sought to gain an understanding of how to incorporate a patient-provider mobile health platform to support the delivery of integrated primary care-based mental health services (Collaborative Care) to rural patients with post-traumatic stress disorder and/or bipolar disorder. Methods: Using the Principles for Digital Development as a framework, we describe our experience designing, developing, and deploying a patient-facing smartphone application that integrates with a clinical patient registry to support Collaborative Care. We extracted mobile metadata to describe the early adoption and use of the system, and report preliminary results from an in-app patient feedback survey that includes a System Usability Scale. Results: Each of the nine Principles for Digital Development is illustrated with examples. The first 10 patients to use the smartphone app have completed symptom measures on average every 14 days over an average period of 20 weeks. The mean System Usability Scale score at week 8 among four patients who completed this measure was 91.9. We present lessons learned about the technical and training requirements for integration into practice that can inform future efforts to incorporate health technologies to improve care for patients with psychiatric conditions. Conclusions: Adhering to the Principles for Digital Development, we created and deployed a mobile health system to support Collaborative Care for patients with complex psychiatric conditions in rural health centers. Preliminary data among the initial users support high system usability and show promise for sustained use. Based on our experience, we propose five additional principles to extend this framework and inform future efforts to incorporate health technologies to improve care for patients with psychiatric conditions: Design for

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A Solution-Focused Research Approach to Achieve an Implementable Revolution in Digital Mental Health

Cited by 153 publications

References 7 publications

How Inclusive, User-Centered Design Research Can Improve Psychological Therapies for Psychosis: Development of SlowMo

How Inclusive, User-Centered Design Research Can Improve Psychological Therapies for Psychosis: Development of SlowMo

Public Attitudes Toward Guided Internet-Based Therapies: Web-Based Survey Study (Preprint)

Applying the Principles for Digital Development: Case Study of a Smartphone App to Support Collaborative Care for Rural Patients With Posttraumatic Stress Disorder or Bipolar Disorder (Preprint)

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