JMIR Publications

ABSTRACT

Background:

Borderline personality disorder (BPD) is a debilitating disorder characterized by difficulties with regulating emotions and impulsive behavior. Monitoring progress in BPD treatment constitutes a challenge for health care professionals and patients alike, especially regarding the long-term overview. A mobile application accessible to patients and therapists at all times contributing to enhanced structure and overview may be usefull during psychotherapy with the emotionally unstable BPD patients.

Objective:

In collaboration with the Danish app-monitoring company Monsenso, we improved and evaluated the usability of a BPD-specific mobile application, the “mDiary system”. The system was aimed at monitoring progress in dialectic behavior therapy (DBT) replacing traditional paper diary card registration. The aim of this study was to examine the feasibility of the mDiary system as well as the generation of a theory of facilitators and obstacles encountered when implementing the mDiary system.

Methods:

The DBT-intervention consisted of a scheduled 56-week out-patient treatment program using the mDiary system as an adjunct to the psychotherapy for patient self-monitoring of mental states and visualizing skill as well as delivering psychoeducative material. Sixteen patients (age: 19-41) and 23 therapists (age: 25-64) from five different Danish public outpatient psychiatric treatment facilities participated in the study. Nine focus group interviews were conducted and analyzed according to the grounded theory approach. The System Usability Scale (SUS) was administered as well. A theory of facilitators and hassles in the implementation was constructed based on feedback from the focus groups.

Results:

The patients were overall satisfied with the mDiary System because it was “easy to use” and “always there”. They rated high usability (SUS score: M=81.2, SD=9.9). Sixteen therapists rated the mDiary system at an average level (M= 68.3, SD= 14.3), contrary to the six therapists involved in the first basic development who were significantly less satisfied with SUS-scores below average level (M = 42.5, SD=16.6). Older age of the users correlated with lower usability ratings on the SUS-score (Pearson’s r=-.60). Instability introduced into the treatment context due to the introduction of new work tasks accompanying development and implementation af a new tecnology was found to influence the implementation negatively. We called this phenomenon inside-out innovation

Conclusions:

Conclusions:

The mDiary system seems to be acceptable way of registering DBT diary data and tracking patients’ skill acquisition. It is now implementable without undue hassles with high patient usability as well as an acceptable therapist usability. The mDiary system is ready for effectiveness studies. In order to ensure successful implementation of similar projects in the future, it is important to be aware of the inside-out part of the innovation processes, which seems easily underestimated.