JMIR Publications

ABSTRACT

Background:

Shared decision-making between clinician and service user is crucial in mental health care. The lack of user-centered services is one of several barriers to this goal. Integrating digital tools into mental health services has the potential to overcome some of these barriers. However, implementing digital tools such as mobile phone apps into mental health care is still sparse, and mental health app attrition rates are generally high. Design thinking may facilitate the development of tools based on service users’ and clinicians’ needs.

Objective:

We aimed to develop and beta test a digital tool for people with severe mental disorders and/or substance use disorders to facilitate shared decision-making regarding treatment goals and strategies in mental health services.

Methods:

We applied a user-centered design to develop “iTandem”, an app for collaborative work in treatment between service users and clinicians. Based on qualitative interviews and workshops with service users with severe mental disorders and/or substance use disorders, clinicians, and relatives, we selected and developed relevant app modules. We conducted beta-testing of iTandem to adjust and plan for a pilot trial in a clinical setting. Safety and ethical issues were discussed and handled.

Results:

To avoid overload for the service users, we applied a pragmatic take on module content and size. Thus, iTandem includes the following eight modules, primarily based on the needs of service users and clinicians: Sleep (sleep diary), Medication (intake and side effects), Recovery (measures: Wellbeing and Personal recovery, exercises: Good things and Personal strengths, Mood (mood diary and report of daily feelings), Psychosis (level of positive symptoms and their consequences, and level of negative symptoms), Activity (goalsetting and progress), Substance use (weekly use, potential triggers and/or strategies used to abstain), and Feedback on therapy (of individual sessions and overall rating of past week). For the beta-testing, service users and clinicians collaborated in choosing 2 - 3 modules in iTandem to work with during treatment sessions. The testing showed that the app was well received by service users, and that facilitation for implementation is crucial.

Conclusions:

iTandem and similar apps have the potential to enhance treatment effects by facilitating shared decision-making and focusing the treatment to meet the needs of the service user. However, implementation must be based on testing, iterations, and utility and treatment effects assessment. We need a new focus on how technology fits into clinical settings, from development to implementation, and we need more research on Early health technology assessment to guide us.