Lessons learned from designing an asynchronous remote community approach for behavioral activation intervention for teens

Background People often prefer evidence-based psychosocial interventions (EBPIs) for mental health care; however, these interventions frequently remain unavailable to people in nonspecialty or integrated settings, such as primary care and schools. Previous research has suggested that usability, a concept from human-centered design, could support an understanding of the barriers to and facilitators of the successful adoption of EBPIs and support the redesign of EBPIs and implementation strategies. Objective This study aimed to identify and categorize usability issues in EBPIs and their implementation strategies. Methods We adapted a usability issue analysis and reporting format from a human-centered design. A total of 13 projects supported by the National Institute of Mental Health—funded Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness Center at the University of Washington used this format to describe usability issues for EBPIs and implementation strategies with which they were working. Center researchers used iterative affinity diagramming and coding processes to identify usability issue categories. On the basis of these categories and the underlying issues, we propose heuristics for the design or redesign of EBPIs and implementation strategies. Results The 13 projects reported a total of 90 usability issues, which we categorized into 12 categories, including complex and/or cognitively overwhelming, required time exceeding available time, incompatibility with interventionist preference or practice, incompatibility with existing workflow, insufficient customization to clients/recipients, intervention buy-in (value), interventionist buy-in (trust), overreliance on technology, requires unavailable infrastructure, inadequate scaffolding for client/recipient, inadequate training and scaffolding for interventionists, and lack of support for necessary communication. These issues range from minor inconveniences that affect a few interventionists or recipients to severe issues that prevent all interventionists or recipients in a setting from completing part or all of the intervention. We propose 12 corresponding heuristics to guide EBPIs and implementation strategy designers in preventing and addressing these usability issues. Conclusions Usability issues were prevalent in the studied EBPIs and implementation strategies. We recommend using the lens of usability evaluation to understand and address barriers to the effective use and reach of EBPIs and implementation strategies. International Registered Report Identifier (IRRID) RR2-10.2196/14990

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“…Test: a pilot study, collecting data on feasibility, usability, user burden, acceptability, and symptom outcomes [ 48 ]…”

Section: Methodsmentioning

confidence: 99%

Usability Issues in Evidence-Based Psychosocial Interventions and Implementation Strategies: Cross-project Analysis

Munson¹,

Friedman²,

Osterhage³

et al. 2022

J Med Internet Res

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“…Of the 33 studies, 6 (18%) involved individuals with lived experience [ 14 , 58 , 62 , 66 , 68 , 70 ], 23 (70%) involved service users [ 6 , 43 - 45 , 47 - 50 , 52 - 55 , 57 , 59 - 61 , 63 - 65 , 67 , 69 , 72 , 73 ], and 4 (12%) involved both [ 46 , 51 , 56 , 71 ]. A total of 18 (55%) studies of the 33 studies included adult participants [ 43 - 47 , 49 - 51 , 54 , 55 , 58 , 60 - 65 , 71 , 72 ], 6 (18%) studies described their participants as young people [ 6 , 52 , 53 , 56 , 59 , 70 ], 3 (9%) studies described their participants as adolescents [ 45 , 68 , 73 ], and 6 (18%) did not specify the age group of their participants [ 14 , 48 , 57 , 66 , 67 , 69 ].…”

Section: Resultsmentioning

confidence: 99%

“…User-centered design was used in 8 studies [ 49 , 51 , 55 , 60 , 61 , 63 , 68 , 71 ], and participatory design was used in 7 studies [ 14 , 46 , 47 , 50 , 62 , 66 , 67 ]. Other identified approaches included value-sensitive design [ 57 ], experience-based co-design [ 52 ], service design [ 54 ], design research [ 59 ], human-centered design [ 73 ], user-centered development [ 65 , 69 ], community-based participatory research [ 44 ], and participatory workshops [ 43 ].…”

Section: Resultsmentioning

confidence: 99%

“…None of the studies included the participants as “listeners,” whereas 16 studies featured participants in the role of a “cothinker” [ 43 , 44 , 46 - 49 , 51 , 54 , 55 , 57 , 61 , 62 , 65 , 66 , 69 , 71 ], providing their opinions on ideas or evaluating test sessions of innovations developed by the researchers. In addition, participants served as “advisers” in 11 studies, offering solicited or unsolicited feedback to researchers and designers [ 14 , 52 , 53 , 56 , 59 , 60 , 63 , 64 , 68 , 70 , 73 ]. In 6 studies, participants functioned as equal “partners” with researchers and designers [ 6 , 45 , 50 , 58 , 67 , 72 ].…”

Section: Resultsmentioning

confidence: 99%

“…As a result, the authors formulated 12 design considerations for the integrated delivery of cognitive behavioral therapy for people with depression. Jenness et al [ 73 ] used a human-centered design process to develop an app to provide an evidence-based psychosocial intervention for teenagers with depression, and they found that it helped teenagers reduce avoidance. Involving service users in the design process led to design changes based on their needs, such as personalizing the timing and frequency of logging reminders based on participants’ routines and times when they felt most comfortable.…”

Section: Resultsmentioning

confidence: 99%

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The Involvement of Service Users and People With Lived Experience in Mental Health Care Innovation Through Design: Systematic Review

Veldmeijer¹,

Terlouw²,

Os³

et al. 2023

JMIR Ment Health

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Background Mental health care faces challenges that not only necessitate innovation but also require the involvement of service users and people with lived experience in developing and evaluating mental health care services. As the development of digital interventions is becoming more prevalent, design approaches are increasingly finding their way into mental health. There is evidence that these approaches can successfully integrate user experience into mental health services. However, there is no clear overview of the studies conducted and the lessons learned concerning the involvement of service users and people with lived experience. Objective In this systematic review, we aimed to provide an overview of the involvement of service users and people with lived experience in mental health care services through design approaches and to synthesize the advantages of design approaches in mental health care. Methods The following 5 databases were searched for relevant abstracts: PsycINFO, PubMed, Web of Science, Scopus, and Embase. In addition, 2 health design journal archives, Design for Health and The Journal of Health Design, were searched. To categorize the results, we collected the reported added value from the included articles and conducted a thematic synthesis in which the themes were developed from the retrieved data. The themes were discussed, revised, and checked until saturation was achieved. Results We included and categorized 33 papers. Most studies involved service users, primarily adults, and used various design approaches. Most of these studies aimed to design or evaluate digital interventions. Service users and people with lived experience were involved in different roles but never as decision makers. Studies that used co-design approaches exhibited the highest levels of involvement. Various added values were reported, including tailoring and testing interventions and digital interventions, improving engagement and collaboration, gathering the needs of stakeholders, and empowering participants as resourceful actors. The challenges reported were maintaining participants’ continued participation throughout the study, managing the iterative nature of design, providing a safe space, balancing insights from design and medical science, and navigating design processes in medical environments. Conclusions This systematic review provides an overview of the studies that used design approaches to involve service users and people with lived experience in mental health care innovation. Design approaches have advantages in mental health care innovation, offering added value and having manageable challenges. Future studies using design approaches in mental health care should involve participants as partners and decision makers and report on collaboration in a systematic and clear manner.

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Expanding, improving, and understanding behaviour research and therapy through digital mental health

Cohen

Schueller

2023

Behaviour Research and Therapy

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Lessons learned from designing an asynchronous remote community approach for behavioral activation intervention for teens

Cited by 7 publications

References 55 publications

Usability Issues in Evidence-Based Psychosocial Interventions and Implementation Strategies: Cross-project Analysis

Usability Issues in Evidence-Based Psychosocial Interventions and Implementation Strategies: Cross-project Analysis

The Involvement of Service Users and People With Lived Experience in Mental Health Care Innovation Through Design: Systematic Review

Expanding, improving, and understanding behaviour research and therapy through digital mental health

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