Accepted for/Published in: JMIR Human Factors
Date Submitted: Sep 18, 2025
Date Accepted: Feb 19, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Adaptation and Acceptability of a Low-Intensity Cognitive Behavioral Therapy App to Support Low Mood and Worry Management in Female Armed Forces Veterans.
ABSTRACT
Background:
Mental health help-seeking barriers experienced by female armed forces veterans result in them being underserved and underrepresented. Efforts are therefore required to adapt interventions for female veterans to enhance acceptability and maximize engagement. Given a smaller number and wider geographical distribution of female veterans, targeting adaptation efforts at a digital mobile phone application based on CBT has potential for greatest impact to improve access to a scalable evidence-based psychological therapy.
Objective:
This study examines the adaptation of a low-intensity CBT app to support low mood and worry management in female armed forces veterans and examines acceptability and usability.
Methods:
Mixed methods comprising a focus group of female armed forces veterans to inform adaptation with extracted themes used as the basis of an adaptation framework. Following adaptation, a wider sample of female veterans were recruited to use the app and complete the mHealth App Usability Questionnaire (MAUQ) to determine acceptability, usability and usefulness.
Results:
Two main areas were identified as requiring adaptation to maximize acceptability and usability. Whilst employing imagery and quotes to reflect the armed forces was initially found helpful to initiate engagement it was considered continued reference to the armed forces should be dropped when progressing through the app. Most app features were found acceptable, however adaptations were requested to the content and structure of signposting information, navigation and the way progress was monitored. No adaptations were however required regarding the CBT techniques employed, with specific app features motivating engagement. Following adaptation there were good levels of acceptability, usability and usefulness.
Conclusions:
Involving female armed forces veterans as part of an intervention adaptation process has promise to improve acceptability and engagement with a digital CBT mobile phone intervention. Ensuring the intervention represented the transition from serving to female armed forces veteran is of particular significance in enhancing acceptability. Clinical Trial: ISRCTN number: ISRCTN50744553. https://www.isrctn.com/ISRCTN50744553
Citation
