JMIR Publications

ABSTRACT

Background:

Patients with borderline personality disorder experience great difficulties in regulating their emotions. They often are unable to effectively detect their emotional arousal and struggle to timely apply learned techniques for emotion regulation. Although the use of continuous wearable biofeedback has been repeatedly suggested as option to improve patients’ emotional awareness, these type of applications are currently not available. To address this gap we applied participatory design to develop an ambulatory biofeedback app named Sense-IT that can be integrated in mental health care.

Objective:

The aim of the study was to develop a stable ambulatory biofeedback app that helps its users in learning to better recognize changes in their emotional arousal and increase emotional awareness.

Methods:

Using a newly developed, tailored User Centered Design framework, we tested the application’s usability and user experience via a cyclic developmental process with multiple user groups (patients, therapists and UCD experts; 3 – 5 per group, per cycle). Several methods of human-centred design were employed, such as two-day ecological field tests, task scenarios, and cognitive walkthroughs while using a think aloud protocol.

Results:

The process resulted in a stable prototype of the app that meets most of all identified user requirements. The app was valued as useful and usable by involved patients, therapists and UCD experts. As most critical usability problems were identified and addressed in the first cycle of the prototyping process, subsequent cycles were mainly about implementing new or extending existing functions, and other future adjustments on improving UX. We describe and discuss the iterative process that led to the current version of the prototype application.

Conclusions:

mHealth development within a clinical mental health setting is challenging, yet feasible and welcomed by targeted users. This paper provides an example of how a newly developed, tailored participatory design approach can deliver an app that is employable in the daily practice of mental healthcare. It shows how mHealth for mental healthcare can be met with enthusiasm and openness by user groups that are known to be reluctant to embrace technological innovations. The use of multiple user groups proved to be of added value during design and realization, and led to a set of four values essential for adoption of technology in the mental health setting. These are presented in terms of 4 H’s: technology needs to be technically Hassle-free, Harmless to the patients and the process of therapy, therapeutically Helping, and needs to provide an experience that makes users Happy to use it. Future directions on studying clinical effectiveness of the app, appliance of the app in other fields, and the implications of integration of the app for daily practice in mental health, are discussed.