Tips and Traps: Lessons From Codesigning a Clinician E-Monitoring Tool for Computerized Cognitive Behavioral Therapy

Abstract

BackgroundComputerized cognitive behavioral therapy (cCBT) is an acceptable and promising treatment modality for adolescents with mild-to-moderate depression. Many cCBT programs are standalone packages with no way for clinicians to monitor progress or outcomes. We sought to develop an electronic monitoring (e-monitoring) tool in consultation with clinicians and adolescents to allow clinicians to monitor mood, risk, and treatment adherence of adolescents completing a cCBT program called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts).ObjectiveThe objectives of our study were as follows: (1) assess clinicians’ and adolescents’ views on using an e-monitoring tool and to use this information to help shape the development of the tool and (2) assess clinician experiences with a fully developed version of the tool that was implemented in their clinical service.MethodsA descriptive qualitative study using semistructured focus groups was conducted in New Zealand. In total, 7 focus groups included clinicians (n=50) who worked in primary care, and 3 separate groups included adolescents (n=29). Clinicians were general practitioners (GPs), school guidance counselors, clinical psychologists, youth workers, and nurses. Adolescents were recruited from health services and a high school. Focus groups were run to enable feedback at 3 phases that corresponded to the consultation, development, and postimplementation stages. Thematic analysis was applied to transcribed responses.ResultsFocus groups during the consultation and development phases revealed the need for a simple e-monitoring registration process with guides for end users. Common concerns were raised in relation to clinical burden, monitoring risk (and effects on the therapeutic relationship), alongside confidentiality or privacy and technical considerations. Adolescents did not want to use their social media login credentials for e-monitoring, as they valued their privacy. However, adolescents did want information on seeking help and personalized monitoring and communication arrangements. Postimplementation, clinicians who had used the tool in practice revealed no adverse impact on the therapeutic relationship, and adolescents were not concerned about being e-monitored. Clinicians did need additional time to monitor adolescents, and the e-monitoring tool was used in a different way than was originally anticipated. Also, it was suggested that the registration process could be further streamlined and integrated with existing clinical data management systems, and the use of clinician alerts could be expanded beyond the scope of simply flagging adolescents of concern.ConclusionsAn e-monitoring tool was developed in consultation with clinicians and adolescents. However, the study revealed the complexity of implementing the tool in clinical practice. Of salience were privacy, parallel monitoring systems, integration with existing electronic medical record systems, customization of the e-monitor, and preagreed monitoring arrangements between clinicians and adolesce...

Social anxiety apps: a systematic review and assessment of app descriptors across mobile store platforms

“…Finally, developers should adhere to evidence-based guidelines and involve users in the development process as has been done in previous work 40. Including users in the development of apps is important41 and has proven successful 42.…”

Is Digital Treatment the Holy Grail? Literature Review on Computerized and Blended Treatment for Depressive Disorders in Youth

“…Sixteen studies were aimed at computerized treatments, of which nine were unguided computerized treatments (four computer-based and five internet-based) [30][31][32][33][34][35][36][37][38] and seven studies were guided computerized treatments (one computer-based and six internet-bases) [39][40][41][42][43][44][45], two studies at blended treatment [46,47], two studies compared unguided computerized, blended-and face-to-face treatment to no treatment [48,49], and eight studies were aimed at self-help internet-based games [50][51][52][53][54][55][56][57]. Furthermore, two studies that were focused on the use of an online monitoring tool aimed at registering and monitoring treatment progression [58,59] and three studies were aimed at characteristics of online interventions or studied the preferred modes of help seeking [60][61][62].…”

“…Sixteen studies were mainly focused on the feasibility, usability, and acceptability of computerized and blended interventions. The study designs were mixed and they contained qualitative studies with focus groups of patients, healthy adolescents or mental health professionals (k = 6) [41,53,54,56,58,59], randomized controlled trials (k = 3) [43,47,48], pre-post designs without control group (k = 5) [31,46,50,51,55], and cross-sectional studies (k = 2) [32,37]. Three studies were mainly focused on the preferences of patients regarding treatment modalities [32,60,62].…”

“…The concern of mental health professionals is that they are not able to monitor risk of self-harm and suicidal ideation in the computerized treatment of depressive disorders [59]. Mental health professionals reported that it was difficult to decide which notifications were actually alarming in the adolescent's condition and needed interference when guided computerized interventions were used [41].…”

“…Consequently, the therapist is not always able to monitor progress and risk. Clinicians participating in a qualitative study suggested that other people in mental service could check for alerting messages [59].…”