JMIR Publications

ABSTRACT

Background:

Problem anger is common after experiencing trauma and is under-recognised relative to other posttraumatic mental health issues. Previous research has shown that digital mental health tools have significant potential to support individuals with problem anger. For digital mental health tools to have optimal engagement and uptake, involvement from end-users to design the tool is essential.

Objective:

The objective of this study is to describe development of a just-in-time adaptive intervention targeting problem anger in individuals who have experienced trauma.

Methods:

We used a participatory design process following the double-diamond framework, involving one-on-one qualitative interviews with trauma-exposed individuals with problem anger (n = 10), and then co-design workshops with digital tool experts (n = 3), and trauma experts (n = 3). We thematically coded interview data to create design principles for this population and generate content for the intervention, which we then took to co-design workshops for feedback.

Results:

Themes included: (1) dislike of mental health apps targeting depression and anxiety, with unique look and feel preferences for digital mental health tools targeting anger; (2) interest in self-led and personalised support and content; and (3) experiencing anger in stages with different support needed at each stage. Based on the design ideas and iterative participant feedback, several modules were developed: personalised schedules and content onboarding; psychoeducation about problem anger; crisis support; mood monitoring via anger check-ins; self-led and personalised circuit breakers; cognitive-behavioural based skills; and a supportive Coach embedded in the app. Some suggested features were not pursued due to feasibility reasons relating to participant safety or technical costs.

Conclusions:

The resulting just-in-time adaptive intervention Shift is the first digital mental health tool designed with end users to manage anger after trauma.