JMIR Publications

ABSTRACT

Background:

Mobile device-based (mHealth) tools to help adolescents practice skills outside of cognitive behavioural therapy (CBT) sessions for treating an anxiety disorder may lead to greater treatment gains.

Objective:

To develop, design, and test the acceptability, learnability, heuristics, and usability of MindClimb, an mHealth app for adolescents with anxiety to use between CBT sessions to plan and complete exposure activities using skills (cognitive, relaxation, exposure practice, and reward) learned in treatment.

Methods:

This was a three-phase study from August 2015 to December 2018. In phase 1, the app was designed and developed in consultation with young people and CBT therapists to identify desired functions and content. Feedback was subjected to thematic analysis using a general inductive approach. In phase 2, two high-fidelity testing sessions took place using the Think Aloud approach (acceptability, learnability, usability) and 10 item System Usability Scale with 10 adolescent receiving CBT. The high fidelity MindClimb app was evaluated by 5 app developers based on Nielsen’s 10 usability heuristics and 5point Severity Ranking Scale. In phase 3, 8 adolescents and 3 therapists assessed the usability of MindClimb during CBT sessions by recording frequency of skills practice, use of MindClimb features, satisfaction with the app, and barriers and facilitators to app use during treatment.

Results:

Feedback from phase 1 consultations indicated that the app should be: 1) responsive to user needs and preferences, 2) easy to use and navigate, 3) relevant content to the practice of CBT for anxiety, and 4) aesthetically appealing. Using this feedback as a guide, a fully functional app prototype for usability testing and heuristic evaluation was developed. In phase 2 Think Aloud and usability data resulted in minor revisions to the app including refinement of exposure activities. The average system usability score was 77 in both testing cycles indicating acceptable usability. The heuristic evaluation by app developers identified only minor errors (e.g. increase loading speed of app content, score of 1 on the Severity Ranking Scale). In phase 3, adolescents considered app features for completing exposure and relaxation modestly helpful (6.2/10 [exposure feature] and 6.4/10 [relaxation]). Both adolescents (average score 11.3/15, SD 1.6) and therapists (average score 10.0/12, 2.6 SD) reported being satisfied with the app.

Conclusions:

The user-centered approach to developing and testing MindClimb resulted in an mHealth app that can be used by adolescents during CBT for anxiety. Evaluation of the use of this app in a clinical practice setting demonstrated that adolescents and therapists generally felt it was helpful for CBT practice outside of therapy sessions. Implementation studies to optimize integration of technology in clinical care and examine the impact of the app + CBT on clinical care processes and patient outcomes are now necessary.