Accepted for/Published in: JMIR Formative Research
Date Submitted: Jul 25, 2022
Date Accepted: Nov 24, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Technology-assisted systems change for suicide prevention in the emergency department: Development and usability of “ReachCare” mobile applications
ABSTRACT
Background:
Many individuals with suicide risk present to acute care settings, like emergency departments (EDs). However, staffing and time constraints mean that many EDs are not well-placed to deliver evidence-based interventions for suicidality. An existing intervention initiated in the ED for patients with suicide risk (ED-SAFE) has been found to be effective but faces trenchant barriers for widespread adoption.
Objective:
Based on the ED-SAFE intervention, we aimed to develop two applications (apps) for patients with suicide risk: a web app guiding patients through safety planning in the ED (“ED app”) and a smartphone app providing patients components of the ED-SAFE program on their phones after discharge (“patient app”). We then sought to test the usability of these apps with patients presenting to the ED with suicide risk.
Methods:
Using a user-centered design framework, we first developed user personas to explore the needs and characteristics of suicidal patients with input from clinicians (n=3) and suicidologists (n=4). Next, we validated these personas during interviews with individuals with lived experience of suicidality (n=6) and used them to inform our application designs. We field-tested the apps with ED patients presenting with suicide risk (n=14) in two iterative cycles to assess usability and engagement using a mixed-methods approach. We also rated the quality/fidelity of the safety plans created.
Results:
We developed two interoperable and complementary apps. The first is a web app, designed for use on a tablet device during ED admission, that guides the patient through creating a safety plan using a chatbot-style interface. The second is a smartphone app for use after discharge and allows the patient to: view, edit, and share their completed safety plan; access self-care education, helplines, and behavioral health referrals; and track follow-up appointments with the study clinician. Initial prototype usability testing (n=9) demonstrated satisfactory scores [ED app System Usability Scale (SUS) mean=78.6/100 (SD=24.1); User Engagement Scale (UES) mean=3.74/5 (SD=0.72); patient app SUS mean=81.7/100 (SD=20.1)]. After refining the apps based on participant feedback, second cycle testing (n=5) showed improvement [ED app SUS mean=90.5/100 (SD=9.9); UES mean=4.07/5 (SD=0.36); patient app SUS mean=97.0/100 (SD=1.9)]. The quality ratings for completed safety plans were satisfactory (Safety Planning Intervention Scoring Algorithm-Brief mean= 27.4, SD= 3.4).
Conclusions:
By adopting a user-centered approach and creating personas to guide development, we were able to create apps for ED patients with suicide risk that received satisfactory usability, engagement, and quality scores. Developing digital health tools based on user-centered design principles that deliver evidence-based intervention components may help to overcome trenchant implementation barriers in challenging healthcare settings. Clinical Trial: NCT04720911
Citation
