JMIR Publications

ABSTRACT

Background:

Bipolar disorder is a serious mental illness that results in significant morbidity and mortality. While pharmacotherapy is the primary treatment for bipolar disorder, adjunctive psychotherapy can assist individuals with using self-management strategies to improve outcomes. However, access to this therapy is limited. Smartphones and other technologies have the potential to increase access to therapeutic strategies that enhance self-management while simultaneously providing real-time user feedback and provider alerts to augment care.

Objective:

To contribute to and support the ongoing improvement and dissemination of technology-based mental health interventions, this paper describes the user-centered development of LiveWell: a smartphone based self-management intervention for bipolar disorder.

Methods:

Individuals with bipolar disorder first participated in a field trial of a simple smartphone application for self-monitoring of behavioral targets. To develop a complete technology-based intervention for bipolar disorder, this field trial was followed by design sessions, usability testing, and a pilot study of a smartphone based self-management intervention for bipolar disorder. Throughout all phases of development, intervention revisions were made based on user feedback.

Results:

The core of the LiveWell intervention consists of a daily self-monitoring tool, the Daily Check In. This self-monitoring tool underwent multiple revisions during the user-centered development process. Daily Check In mood and thought rating scales were collapsed into a single wellness rating scale to accommodate user development of personalized scale anchors. These anchors are meant to assist users in identifying early warning signs and symptoms of impending episodes so they can take action based on personalized plans. When users identified personal anchors for the wellness scale, the anchors most commonly reflected behavioral (40%) followed by cognitive (25%) mood (15%), physical (10%) and motivational (7%) signs and symptoms. Changes to the Daily Check In were also made to help users distinguish between getting adequate sleep and keeping a regular routine. At the end of the pilot study, users reported that the Daily Check In made them more aware of early warning signs and symptoms as well as how much they were sleeping. Users also reported that they liked personalizing their anchors and plans and felt this process was useful. Users experienced some difficulties with developing, tracking, and achieving target goals. Users also did not consistently follow up with application recommendations to contact providers when Daily Check In data suggested they needed additional assistance. As a result, the human support roles for the technology were expanded beyond application use support to include support for self-management and clinical care communication. Developing these human support roles was aided by obtaining feedback on the usability of the technology not only from the users but also from the coaches who provided the human support.

Conclusions:

User input guided development of intervention content, technology, and coaching support for LiveWell. Users valued the provision of monitoring tools and the ability to personalize plans for staying well supporting the role of monitoring and personalization as important features of digital mental health technologies. Users also valued human support of the technology in the form of a coach and user difficulties with aspects of self-management and communication with care providers led to expansion of the coaching support roles. Obtaining feedback from both users and coaches played an important role in the development of both the LiveWell technology and human support. This suggests that attention to all stakeholders involved in the use of mental health technologies is important to optimizing intervention development. Clinical Trial: ClinicalTrials.gov identifiers: NCT02405117, NCT03088462