JMIR Publications

ABSTRACT

Background:

Specialised mental health services are currently facing a high demand for psychological treatment, potentially leading to lower quality of care. Preparing patients for various aspects of attending psychotherapy by providing psychoeducation could one of several solutions to this problem. Here, digital pre-therapy psychoeducation may be of special interest, as these interventions are typically more scalable. However, the effectiveness of these interventions depends on user engagement and satisfaction, where usability is one of the most important factors.

Objective:

Co-creating interventions has gained recognition as being crucial for developing interventions that are both relevant and effective. Based on this principle, this paper has two objectives. The first study aims to describe the development process of StartHelp, a co-created digital pre-therapy psychoeducation programme for patients on waiting lists prior to their first consultation in outpatient specialised mental health services. The second study aims to evaluate the usability and satisfaction of the intervention.

Methods:

Following the GRIPP2 reporting checklist and guided by co-creation principles, StartHelp was developed in close collaboration with user representatives and clinicians, striving to ensure that all stakeholders were partners throughout the development and testing phases. To assess the usability of StartHelp, ten patients from specialised mental health care were recruited to complete tasks within the programme during individual think-aloud interviews. Afterwards, they answered a battery of questionnaires, which included open-ended questions, their perceived quality of videos, the System Usability Scale (SUS), the Client Satisfaction Questionnaire-4 item version (CSQ-4), and a modified version of the CSQ-4 (CSQ-Video). The results were discussed by the workgroup that developed StartHelp, and solutions to the identified usability issues were suggested and implemented.

Results:

Study one: after 24 months, StartHelp was created, comprising a total of 27 “tasks.” These tasks included 24 videos in total, and links to 14 websites containing in-depth information. Study two: Five men and five women were included in the usability testing. SUS scores indicated good usability with a mean of 85. Mean scores on the CSQ-video (M = 10.9) indicated medium to low satisfaction. However, patients perceived the videos as having high quality. Low satisfaction scores may therefore be explained by the testing context. The videos were generally rated as non-offensive. The qualitative findings supported quantitative findings. The revealed usability issues were mainly about navigating the overarching technological infrastructure on which StartHelp was developed.

Conclusions:

Following a co-creation process and usability testing, with only minor adjustments required, StartHelp was deemed suitable for real-world testing in a clinical trial involving patients awaiting their first session in specialised mental health care. SUS scores indicated high usability. The medium-level scores on satisfaction and the tensions that may arise between the development of individual applications and their integration into larger “legacy” infrastructures are discussed.