Designing an mHealth Intervention for People With Visible Differences Based on Acceptance and Commitment Therapy: Participatory Study Gaining Stakeholders’ Input

Abstract

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.

Design Frameworks for Mobile Health Technology

“…evaluation Evidence-based evaluations provide critical insights for mHealth research and development and inspire future studies and implementations. Evaluation data were often collected through multiple methods (see Table 3), such as interviews (e.g., Buman et al, 2016;Dhillon et al, 2016;Mores, et al, 2021;Vossebeld, et al, 2019), app usage data (e.g., Buman et al, 2016;Dhillon et al, 2016), survey questionnaires (e.g., Buman et al, 2016;Dhillon et al, 2016;Farao et al, 2020;Goldstein et al, 2017;Halttu & Oinas-Kukkonen, 2017), focus groups (e.g., Henry et al, 2019;Morse et al ;Zucchelli et al 2021) and observations (e.g., Farao et al, 2020;Morse et al, 2021;Vossebeld, et al, 2019;Zucchelli et al 2021). Researchers (e.g., Morse et al, 2021;Portze et al, 2020;Singh et al, 2020) emphasize that user feedback is a key for usability evaluations of mHealth technologies, as the ease of use contributes positively to the overall adoption of mHealth interventions.…”

“…Among the various frameworks, the Persuasive System Design Framework was applied in three studies (i.e.,Halttu & Oinas-Kukkonen, 2017;Kelders, Kok, Ossebaard, & Van Gemert-Pijnen, 2012;Oinas-Kukkonen, & Harjumaa, 2009). In the latest studies, user-centered framework(Bricker et al, 2020;Farao et al, 2020), human-centered iterative design principles(Morse et al, 2021;Portz et al, 2020) and participatory design framework(Zucchelli et al, 2021) were applied.…”

“…(2020);Morse et al, 2021;Zucchelli et al 2021 design Frameworks and GuidelinesdISCUSSIoNS mHeath Research & developmentThis state-of-the-art review has found that mHealth research and development often involve the following cycle of actions: interventions goals, design guidelines, features and functionalities, and evaluation. As illustrated in Figure1, design guidelines and evaluations are not always evident in mHealth research reports, and thus are noticeably smaller in size and with dotted lines to indicate the lack of such in many cases.…”

An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals With a Visible Difference: Mixed Methods Feasibility Study

“…The involvement of key stakeholders at the design stage of an app program, including end users from the intended population and clinicians with relevant expertise, is also paramount to optimize its appeal, accessibility, and trustworthiness [ 28 ]. For this reason, the intervention investigated in this study was designed using participatory design methods involving individuals with visible differences and clinicians with relevant expertise, as detailed in a previous article [ 29 ].…”

A brief online writing intervention improves positive body image in adults living with dermatological conditions

“…Self-help interventions have the potential to provide flexible and discrete access to psychological interventions ( 18 ). However, existing evidence for specific self-help interventions targeting body image in adults living with a dermatological condition and/or visible differences is currently limited ( 19 – 21 ).…”