JMIR Publications

ABSTRACT

Background:

Exposure and response prevention (ERP) is gold-standard non-pharmacological treatment for obsessive–compulsive disorder (OCD), but difficulty accessing services, poor motivation, difficulty understanding instructions between-sessions limit its implementation. Digital apps have the potential to overcome these barriers and hence there is a need to understand users’ experiences and preferences for developing culturally appropriate digital support/app.

Objective:

To explore lived experiences of OCD, perspectives on digital mental health interventions, and expectations from a therapist-assisted ERP smartphone app in India.

Methods:

This exploratory qualitative study recruited 25 adults with an ICD-10 diagnosis of OCD, illness duration exceeding two years, and smartphone access from psychiatric outpatient services at a tertiary care hospital. Exclusion criteria were predominantly obsessional symptoms without overt compulsions, significant depressive symptoms (BDI-II score >14), current suicidal ideation, and severe psychiatric or physical illness that could interfere with participation. Consenting participants took part in two focus group discussions and two participatory co-design workshops, which explored illness experiences, treatment access, smartphone use, and expectations of digital support and creation of paper prototype of an app. All sessions were recorded and transcribed verbatim. Transcripts, field notes, and design artefacts were analysed thematically using Braun and Clarke’s six-phase framework.

Results:

Ten themes encompassed illness and treatment experiences, functional and relational difficulties, psychotherapy access and practice, and expectations from the app and its design. Participants described a gap between understanding ERP during therapy and implementing it independently. Desired features included multilingual support, demonstration and psychoeducation videos, personalization and gamification, distress ratings, homework reminders and progress summaries. Participants valued simple navigation, affordability, privacy, and supportive human connection. Views differed regarding family access, pricing, and supplementary relaxation or affirmation features. Concerns included limited empathy in digital interactions, excessive monitoring, and dependence on technology.

Conclusions:

Participants envisaged a culturally responsive ERP application that extends therapist support into everyday settings while preserving autonomy and privacy. These findings can inform app development, which will need to undergo subsequent usability, feasibility, and clinical evaluation across diverse Indian clinical populations. Clinical Trial: N/A. Ethics - AIIMSA00773/02-02-2024 dated 08-05-24