JMIR Publications

ABSTRACT

Background:

As patients can struggle to make good use of psychotherapy due to deficits in awareness, digital technologies that support awareness are at a premium. Currently, when patients participate in cognitive analytic therapy (CAT), the technology supporting relational awareness work has been via completion of paper-based worksheets as between-session tasks.

Objective:

To co-design, with therapists and patients, a prototype digital mobile application. This was to help patients better engage in the ‘recognition’ phase of the CAT treatment model, through providing an unobtrusive means for practicing relational awareness with dynamic feedback on progress.

Methods:

A national online survey with CAT therapists (n = 50) to determine readiness for adoption of a mobile application in clinical practice, identify core content, functionality and potential barriers to adoption. A prototype mobile-app based on these data and the existing paper-based worksheets was built. Initial face-to-face user testing of the prototype system was completed with N=3 therapists and N=3 ex-CAT patients.

Results:

Of therapists surveyed, 72% reported not currently using any digital tools during CAT. However, the potential value of a mobile app to support patient awareness was widely endorsed. Areas of therapist’s concern were data security, data governance and equality of access. These concerns were mirrored during subsequent user-testing by CAT therapists. Ex-patients generated additional user specifications on the design, functionality and usability of the app. Results from both streams were integrated to produce five key changes for the reiteration of the app.

Conclusions:

The co-design process has enabled a prototype ‘CAT-app’ to be developed to enhance the relational awareness work of CAT This means that patients can now practice relational awareness in a much more unobtrusive manner and with ongoing dynamic feedback of progress. Testing the acceptability and feasibility of this technological innovation in clinical practice is the next stage in the research process, which has since been conducted and is in submission (Kellett et al). Important challenges of data protection and governance must be navigated in order to ensure implementation and adoption, should the CAT-app be found to be acceptable and clinically effective.