JMIR Publications

ABSTRACT

Background:

Digital health tools are increasingly used to deliver behavioral interventions, yet many therapeutic apps are created without systematic planning, interdisciplinary input, or validated content review. Poorly designed materials can weaken engagement, widen health literacy gaps, and obscure true intervention effects through expectancy or “digital placebo” influences. Structured and methodologically rigorous development processes are needed across digital health systems, particularly in substance use disorder treatment where engagement remains low.

Objective:

To describe and evaluate a practical, platform-agnostic framework for developing, refining, and appraising digital therapeutic modules. The goal was to show how a systematic, iterative approach can improve content quality, increase actionability, and establish a foundation for continuous quality improvement in digital health interventions.

Methods:

This quality-improvement study used a structured, interdisciplinary content development process within a mobile digital therapeutic environment for substance use disorder treatment. Evidence-based clinical materials were adapted for mobile delivery and iteratively revised by an addiction psychiatrist, licensed counselors, and a doctoral-level health education specialist. Four independent reviewers assessed the finalized modules using the Patient Education Materials Assessment Tool (PEMAT) for understandability and actionability. Descriptive statistics summarized domain scores.

Results:

Fourteen therapeutic modules were evaluated. Mean understandability across modules was 87.2% (SD = 4.8, range = 81.4–96.9), exceeding the recommended 70% threshold for all modules. Mean actionability was 75.1% (SD = 12.3, range = 57.1–95.0); five modules scored below the actionability threshold. Variability across reviewers and domains indicated differences in how content features supported user comprehension and identification of actionable steps.

Conclusions:

This study represents one of the first structured evaluations of an interdisciplinary, iterative process for creating and assessing digital therapeutic content. The majority of the developed content meets or exceeds validated quality benchmarks. Variability in actionability scores emphasizes the need for continuous strategic planning rather than one-time design cycles. Integrating structured appraisal frameworks such as the PEMAT into ongoing digital health planning can strengthen content quality, enhance user engagement, and support more accurate evaluation of digital interventions. Incorporating expectancy-sensitive measures and iterative testing may further align digital therapeutic development with established strategic planning approaches and help optimize digital health transformation efforts.