JMIR Publications

ABSTRACT

Background:

Attention is at the base of more complex cognitive processes and is used in everyday tasks. It contributes to cognitive efficiency and attentional deficits can have significant impact on the safety and health of individuals. Indeed, attention can be impaired by neurodevelopmental and acquired disorders, such as traumatic brain injury. One of the most accepted and empirically validated theoretical models to explain attention processes and its deficit is the hierarchical model of Sohlberg and Mateer (1987). This model has been used in the development of interventions to improve attention following an acquired disorder. Another way to stimulate and optimize attention functions is to engage in daily practice of mindfulness, a multicomponent concept for which several theoretical models have been proposed, including that of Baer and colleagues (2008). To practice mindfulness daily, mobile applications offer great potential as they can easily be used during daily routines, thus facilitating transfer. Laverdière and colleagues (2023) have developed such a mobile application called Focusing aimed at attention training using mindfulness-inspired attentional exercises. The Focusing mobile application includes fifteen attentional focus exercises targeting focused, sustained, selective, alternating and divised attention processes. However, this application has not been scientifically validated.

Objective:

This research based on the Vogt, King and King (2004) framework had two aims about the Focussing application: to analyze its logical content validity and its ecological content validity.

Methods:

The logical content validation was done by seven experts in neuropsychology and mindfulness. Using an online questionnaire, they had to determine whether the content of the attention training application exercises is representative of the selected constructs, namely the theoretical model of attention of Sohlberg and Mateer (1987) and the theoretical five facets model of mindfulness of Baer and his colleagues (2008). A focus group was subsequently held with the experts to discuss items that did not reach consensus in order to change or remove them. The ecological content validation was carried out with ten healthy adults. Participants had to explore all sections of the application and assess, using online questionnaires, the usability, relevance, satisfaction, quality, attractiveness and cognitive load associated with each section of the application.

Results:

The results for the logical content validation demonstrated high content validity index (CVI) of the attention training application. All exercises in the application reached excellent scores ( CVI ≥ 0.78) for both attention and mindfulness models, except for two exercises. One of these exercises was subsequently modified to include expert feedback, and one was removed. Regarding the ecological content validation, the results show that workload, quality, user experience, satisfaction and relevance of the application is adequate. The MARS questionnaire shows an average quality rating between 3.75/5 (± 0.41) (objective quality) and 3.65/5 (±0.36) (subjective quality) demonstrating an acceptable quality level. The Mean Global Attractiveness rating from the AttrakDiff questionnaire was 2.36/3 (± 0.57), which represents one of the strengths of the application.

Conclusions:

Logical and ecological content validation showed that the Focusing mobile application is theoretically valid, with a high level of agreement among experts and healthy participants. This tool can now be tested to train attention processes after a neurological insult such as traumatic brain injury.