JMIR Publications

ABSTRACT

Background:

The rising burden of disease associated with mental disorders calls for evidence-based psychological interventions that can be swiftly scaled up. Blending smartphone-based mental health apps (MHapps) for delivering ecological momentary interventions (EMIs) with traditional in-person interventions may have the benefits of improving treatment adherence, the application of learned techniques into everyday life and, in turn, enhancing clinical response. However, previous work has shown that most existing MHapps were developed for specific research studies or for profit, thereby making them difficult to adapt, particularly in time-limited and resource-scarce settings.

Objective:

Using a phased approach, this study aimed to demonstrate how a person-centred and theory-informed MHapp could be developed in a timely and low-cost manner for use as part of blended care. Given the scarcity of digital mental health interventions for older adults, we adopted a participatory research approach to co-designing the blended intervention with two groups of older adults.

Methods:

In Phase 1, we reviewed existing MHapps with consideration of whether they can be adapted by individual researchers or clinicians, their key functions, and whether their efficacy has been tested. ‘No-code’ app builders were additionally reviewed, which may be alternatives if no MHapp can be utilised. In Phase 2, following the IDEAS framework, we built a prototype according to users’ needs, with its content informed by cognitive and behaviour theories (cognitive behavioural therapy [CBT] and the Health Action Process Approach [HAPA]). The prototype was then tested and refined over two rounds of 3-session co-design workshops with Peer Supporters (n = 8) and service users (n = 5) from a stepped-care intervention for older adults with depressive symptoms. Usability testing was conducted with both stakeholder groups in Phase 3.

Results:

Of the 149 MHapps identified, only 43 (28.9%) can be publicly downloaded. Four of them (8.3%) can be partially adapted, although no new content can be directly added. We therefore developed the MHapp using m-Path, which was the only existing no-code app development platform designed for mental health interventions. A prototype incorporating CBT-based homework and behaviour change techniques informed by the HAPA was built, with its refined version rated as highly easy to use and acceptable by both stakeholder groups.

Conclusions:

By integrating EMI with CBT, we demonstrated the feasibility and acceptability of a novel blended care model for reference in future work. Preliminary findings suggest high usability and clinical relevance, highlighting the potential of leveraging no-code platforms to facilitate scalable, theory-driven interventions that extend mental health support beyond traditional settings. Grounding the blended intervention in evidence-based psychological and health behaviour change theories, coupled with user involvement throughout the design process, may substantially improve clinical efficacy and reduce implementation barriers, which are areas for further investigations in future work. Clinical Trial: n/a