A mobile phone-based app for use during cognitive behavioral therapy for adolescents with anxiety (MindClimb): User-centered design and usability study

Amanda Newton, Alexa Bagnell, Rhonda Rosychuk, Janelle Duguay, Lori Wozney, Anna Huguet, Joanna Henderson, Janet Curran

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Resumen

Background: Mobile device-based tools to help adolescents practice skills outside of cognitive behavioral therapy (CBT) sessions for treating an anxiety disorder may lead to greater treatment gains. Objective: This study aimed to develop, design, and test the acceptability, learnability, heuristics, and usability of MindClimb, a smartphone-based app for adolescents with anxiety to use between CBT sessions to plan and complete exposure activities using skills (cognitive, relaxation, exposure practice, and reward) learned in treatment. Methods: This 3-phase study took place from August 2015 to December 2018. In phase 1, the app was designed and developed in consultation with young people and CBT therapists to identify desired functions and content. Feedback was subjected to thematic analysis using a general inductive approach. In phase 2, we conducted 2 high-fidelity testing sessions using the think-aloud approach (acceptability, learnability, usability) and 10-item System Usability Scale with 10 adolescents receiving CBT. The high-fidelity MindClimb app was evaluated by 5 app developers based on Nielsen's usability heuristics and 5-point severity ranking scale. In phase 3, a total of 8 adolescents and 3 therapists assessed the usability of MindClimb during CBT sessions by recording the frequency of skills practice, use of MindClimb features, satisfaction with the app, and barriers and facilitators to app use during treatment. Results: Feedback from phase 1 consultations indicated that the app should (1) be responsive to user needs and preferences, (2) be easy to use and navigate, (3) have relevant content to the practice of CBT for anxiety, and (4) be aesthetically appealing. Using this feedback as a guide, a fully functional app prototype for usability testing and heuristic evaluation was developed. In phase 2, think-aloud and usability data resulted in minor revisions to the app, including refinement of exposure activities. The average system usability score was 77 in both testing cycles, indicating acceptable usability. The heuristic evaluation by app developers identified only minor errors (eg, loading speed of app content, with a score of 1 on the severity ranking scale). In phase 3, adolescents considered app features for completing exposure (6.2/10) and relaxation (6.4/10) modestly helpful. Both adolescents (average score 11.3/15, SD 1.6) and therapists (average score 10.0/12, 2.6 SD) reported being satisfied with the app. Conclusions: The user-centered approach to developing and testing MindClimb resulted in a mobile health app that can be used by adolescents during CBT for anxiety. Evaluation of the use of this app in a clinical practice setting demonstrated that adolescents and therapists generally felt it was helpful for CBT practice outside of therapy sessions. Implementation studies with larger youth samples are necessary to evaluate how to optimize the use of technology in clinical care and examine the impact of the app plus CBT on clinical care processes and patient outcomes.

Idioma originalEnglish
Número de artículoe18439
PublicaciónJMIR mHealth and uHealth
Volumen8
N.º12
DOI
EstadoPublished - dic. 2020

Nota bibliográfica

Funding Information:
The authors would like to acknowledge the contributions of the NYAC youth engagement facilitators who assisted with youth consultation in phase 1; Marcus O'Neill, who helped to coordinate the study; and Jason Murray from Optio Publishing Inc, who helped to develop MindClimb. The study team would also like to thank the Treatment of Anxiety group at the IWK Health Centre in Halifax, Nova Scotia, and the clinicians and adolescents who participated in this study and the creation of MindClimb. This study was funded by the Canadian Institutes of Health Research (CIHR KAL 139705).

Funding Information:
The authors would like to acknowledge the contributions of the NYAC youth engagement facilitators who assisted with youth consultation in phase 1; Marcus O’Neill, who helped to coordinate the study; and Jason Murray from Optio Publishing Inc, who helped to develop MindClimb. The study team would also like to thank the Treatment of Anxiety group at the IWK Health Centre in Halifax, Nova Scotia, and the clinicians and adolescents who participated in this study and the creation of MindClimb. This study was funded by the Canadian Institutes of Health Research (CIHR KAL 139705).

Publisher Copyright:
© 2020 JMIR Publications. All rights reserved.

ASJC Scopus Subject Areas

  • Health Informatics

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