The evidence for using digital technologies to improve outcomes in mental health care is growing at a rapid rate. Already, studies have highlighted how technology can be used to effectively provide well-established treatments, such as cognitive behavioral therapy.1 The unique capabilities of some technologies are also allowing the development of new therapies, such using virtual reality-based exposure therapy for PTSD.2 Furthermore, with ownership levels at more than 92 per 100 inhabitants in developing nations, the ubiquity of mobile phones has enabled the delivery of mental health care on a scale larger than ever before, particularly in areas with high demand and limited local resources.3,4
There are an enormous number of smartphone apps that claim to help with mental health problems, with many being free for download. However, their potential for positive impact remains unclear. Few have had their effects on outcomes rigorously evaluated. Their availability is also sporadic, often downloadable from app stores one month, then absent the next.5,6 Although research indicates patients are keen to use them, of the apps currently available, most are deleted after only a few uses.7–9
Building knowledge of the effect of apps on clinical outcomes is key to defining their true role in care. However, to ensure positive effects are realized, we need also to consider how best to design and implement them for patients with mental health conditions. To do this, greater understanding of the user experience (UX) of mental health apps is needed.
UX fundamentally refers to the dynamic, subjective and context-dependent way in which a user engages with a product or system.10,11 In the case of mental health apps, investigating UX can help us understand the knowledge and expectations of technology that patients have developed from their own personal use. Through this, we can begin to understand why current apps are so readily deleted despite persistent interest in using them, and we can determine the key characteristics of successful alternatives.
1. Olthuis JV, Watt MC, Bailey K, et al. Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev. 2016;3:CD011565.
2. Gonçalves R, Pedrozo AL, Coutinho ES, et al. Efficacy of virtual reality exposure therapy in the treatment of PTSD: a systematic review. PLoS One. 2012;7:e48469.
3. World Health Organization. Global diffusion of eHealth: Making universal health coverage achievable. Report of the third global survey on eHealth. 2016. http://who.int/goe/publications/global_diffusion/en. Accessed January 29, 2018.
4. World Health Organization. Mental Health Action Plan 2013-2020. 2013. http://www.who.int/mental_health/publications/action_plan/en. Accessed January 29, 2018.
5. Larsen ME, Nicholas J, Christensen H. Quantifying App Store Dynamics: Longitudinal Tracking of Mental Health Apps. JMIR mHealth uHealth. 2016;4:e96.
6. Bakker D, Kazantzis N, Rickwood D, Rickard N. Mental health smartphone apps: review and evidence-based recommendations for future developments. JMIR Ment Heal. 2016;3(1):e7.
7. Firth J, Torous J. Smartphone apps for schizophrenia: a systematic review. JMIR mHealth uHealth. 2015; 3. DOI:10.2196/mhealth.4930.
8. Nicholas J, Fogarty AS, Boydell K, Christensen H. The Reviews Are in: A Qualitative Content Analysis of Consumer Perspectives on Apps for Bipolar Disorder. J Med Internet Res. 2017;19:e105.
9. Consumer Health Information Corporation. Consumer-health. Motivating patients to use smartphones health apps. http://www.consumer-health.com/motivating-patients-to-use-smartphone-health-apps. Accessed January 29, 2018.
10. Abrahão S, Bordeleau F, Cheng B, et al. User Experience for Model-Driven Engineering: Challenges and Future Directions. http://eprints.whiterose.ac.uk/118523/1/MODELS2017_paper_130.pdf. Accessed January 29, 2018.
11. Law EL-C, Roto V, Hassenzahl M, et al. Understanding, scoping and defining user experience. Proceedings of the 27th International Conference on Human Factors in Computing Systems - CHI 09. New York: ACM Press; 2009: 719.
12. American Psychiatric Organization. App Evaluation Model. 2017; 52: 1–1. https://www.psychiatry.org/psychiatrists/practice/mental-health-apps/app....
13. Matthew-Maich N, Harris L, Ploeg J, et al. Designing, Implementing, and Evaluating Mobile Health Technologies for Managing Chronic Conditions in Older Adults: A Scoping Review. JMIR mHealth uHealth. 2016;4:e29.
14. ISO. Ergonomics of Human-System Interaction - Usability Methods Supporting Human-Centred Design. Geneva, Switzerland: Author, 2002.
15. Bangor A, Kortum PT, Miller JT. Determining What Individual SUS Scores Mean: Adding an Adjective Rating Scale. J Usability Stud. 2009;4:114–123.
16. Hertzum M. Commentary: Usability—A Sensitizing Concept. Human-Computer Interact. 2017;1–4.
17. hou L, Bao J, Parmanto B. Systematic Review Protocol to Assess the Effectiveness of Usability Questionnaires in mHealth App Studies. JMIR Res Protoc 2017; 6: e151.
18. Donker T, Petrie K, Proudfoot J, Clarke J, Birch M, Christensen H. Smartphones for smarter delvery of mental health programs: a systematic review. J Med Internet Res 2013; 15. DOI:e247.