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

Abstract

BackgroundDespite 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.ObjectiveThe aim of this study was to seek to gain an understanding of how to incorporate a patient-provider mobile health (mHealth) platform to support the delivery of integrated primary care–based mental health services (Collaborative Care) to rural patients with posttraumatic stress disorder and/or bipolar disorder.MethodsUsing the Principles for Digital Development as a framework, we describe our experience designing, developing, and deploying a mobile system to support Collaborative Care. The system consists of a patient-facing smartphone app that integrates with a Web-based clinical patient registry used by behavioral health care managers and consulting psychiatrists. Throughout development, we engaged representatives from the system’s two user types: (1) providers, who use the Web-based registry and (2) patients, who directly use the mobile app. We extracted mobile metadata to describe the early adoption and use of the system by care managers and patients and report preliminary results from an in-app patient feedback survey that includes a System Usability Scale (SUS).ResultsEach 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 SUS score at week 8 among four patients who completed this measure was 91.9 (range 72.5-100). 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.ConclusionsAdhering to the Principles for Digital Development, we created and deployed an mHealth 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. On the basis of 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 public health impact, add value for all users, test the product and the process, acknowledge disruption, and anticipate variability.

Proposing a standardized, step-by-step model for creating post-traumatic stress disorder (PTSD) related mobile mental health apps in a framework based on technical and medical norms

“…Another important question to address is whether the app should act as an isolated program or be connected to various online databases for the purpose of receiving and sending information, like, e.g. the SPIRIT program (Bauer, Hodsdon, Bechtel, & Fortney, 2018), which has a big impact on which norms to apply concerning data security and integrity. Although the implementation of this has technical challenges, deciding whether the app needs such a connection is a medical consideration based on the desired functionalities of the app.…”

“…A variety of papers and textbooks cover topics of app development (Eisenman, 2018;Griffith, 2017;Singh & Phan, 2018 (Bauer et al, 2018;Digital Principal Working Group, 2018). An open approach to digital development can help to increase collaboration in the digital development community and avoid duplicating work that has already been done (Bauer et al, 2018). To minimize the technical complexity of creating an app, software frameworks have been developed that facilitate the process (e.g.…”

“…There are a variety of recommended principles to fulfil while creating an mHealth app, such as the principles for digital development for technologyenabled service delivery programs (Bauer et al, 2018, see also Box 1).…”

“…Being data driven refers to basing the design decisions on data collected from all stages of development, as well as a rigorous method of collecting those data. An example of this is the methodical collection of feedback from beta-testers and incorporating the lessons learned into the final app (Bauer et al, 2018). Using open standards, open data, open source and open innovation is a fundamental principle when developing software, because using already existing tools saves time and money.…”

“…Using open standards, open data, open source and open innovation is a fundamental principle when developing software, because using already existing tools saves time and money. The SPIRIT app, for instance, was developed using CommCare, an open source mobile data collection platform (Bauer et al, 2018). Reusing and improving on preliminary work such as already existing apps also saves scarce resources and makes it easy to avoid starting a project from scratch.…”