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)

Abstract

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