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Through the Practitioner's Lens: A Qualitative Exploration of Kalmer as an Ecological Momentary Intervention for Nonsuicidal Self-injury
ABSTRACT
Background:
Nonsuicidal self-injury (NSSI) is prevalent among adolescents and adults attending primary care and specialized mental health services. Limited appointment frequency and increasing demand across public mental health services create gaps in support between sessions. Ecological Momentary Intervention (EMI) apps such as Kalmer may help extend care into patient’s daily environments.
Objective:
This study explored how healthcare professionals perceive the usefulness, acceptability, and potential implementation of Kalmer, a mobile EMI app to support individuals with NSSI.
Methods:
Two online focus groups were conducted with fourteen healthcare professionals from primary care and specialized mental health services who used Kalmer for two weeks. Data were analyzed using Naeem et al.’s (2025) Structured Thematic Analysis framework. The System Usability Scale (SUS) and the user version of the Mobile Application Rating Scale (uMARS) were used to assess usability and aspects of the app’s quality.
Results:
Four interrelated themes were identified, 1) Kalmer as an immediate emotional anchor; 2) a digital extension of therapeutic care; 3) a pragmatic response to an overstretched system; 4) from digital content to digital therapy: what Kalmer must become. Results from the System Usability Scale (SUS) showed high usability (mean= 80.18) and strong ratings for information and engagement on the uMARS, while moderate perceived impact scores reflected concerns about engagement.
Conclusions:
Professionals view Kalmer as a valuable adjunct to care, particularly for supporting momentary emotional dysregulation between sessions. However, concerns regarding engagement, design, ethical positioning and clinical responsibility highlight the need for careful implementation, including training, clear framing, and alignment with stepped care approaches to support sustainable and responsible integration into practice. These insights inform the refinement of Kalmer and guide future research in EMI interventions for individuals with NSSI.
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