1. Development of an Ambulatory Biofeedback App to Enhance Emotional Awareness in Patients with Borderline Personality Disorder: Multicycle Usability Testing Study
- Author
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Ernst Thomas Bohlmeijer, Gerben Johan Westerhof, Randy Klaassen, Youri P.M.J. Derks, Matthijs Leendert Noordzij, and Psychology, Health & Technology
- Subjects
Adult ,Male ,050103 clinical psychology ,ambulatory biofeedback ,Cognitive walkthrough ,medicine.medical_treatment ,Applied psychology ,Psychological intervention ,Health Informatics ,Information technology ,Biofeedback ,03 medical and health sciences ,0302 clinical medicine ,User experience design ,Borderline Personality Disorder ,Surveys and Questionnaires ,medicine ,Humans ,0501 psychology and cognitive sciences ,user centered design ,mHealth ,mobile health ,User-centered design ,Original Paper ,iterative prototype testing ,business.industry ,design science ,05 social sciences ,Usability ,Biofeedback, Psychology ,Middle Aged ,T58.5-58.64 ,Mental health ,Mobile Applications ,Emotional Regulation ,emotional awareness ,Female ,Ergonomics ,Public aspects of medicine ,RA1-1270 ,business ,Psychology ,030217 neurology & neurosurgery ,mental health - Abstract
BackgroundPatients with borderline personality disorder experience great difficulties in regulating their emotions. They often are unable to effectively detect their emotional arousal and struggle to timely apply learned techniques for emotion regulation. Although the use of continuous wearable biofeedback has been repeatedly suggested as an option to improve patients’ emotional awareness, this type of app is not yet available for clinical use. Therefore, we developed an ambulatory biofeedback app named Sense-IT that can be integrated in mental health care.ObjectiveThe aim of the study was to develop an ambulatory biofeedback app for mental health care that helps with learning to better recognize changes in personal emotional arousal and increases emotional awareness.MethodsUsing several methods in a tailored User Centred Design (UCD) framework, we tested the app’s usability and user experience (UX) via a cyclic developmental process with multiple user groups (patients, therapists, and UCD experts; 3-5 per group, per cycle).ResultsThe process resulted in a stable prototype of the app that meets most of the identified user requirements. The app was valued as useful and usable by involved patients, therapists, and UCD experts. On the Subjective Usability Scale (SUS), the patients rated the app as “Good” (average score of 78.8), whereas the therapists rated the app as “OK” (average score of 59.4). The UCD experts judged the app’s overall usability as between “OK” and “acceptable” (average score of 0.87 on a cognitive walkthrough). As most critical usability problems were identified and addressed in the first cycle of the prototyping process, subsequent cycles were mainly about implementing new or extending existing functions, and other adjustments to improve UX.ConclusionsmHealth development within a clinical mental health setting is challenging, yet feasible and welcomed by targeted users. This paper shows how new mHealth interventions for mental health care can be met with enthusiasm and openness by user groups that are known to be reluctant to embrace technological innovations. The use of the UCD framework, involving multiple user groups, proved to be of added value during design and realization as evidenced by the complementary requirements and perspectives. Future directions on studying clinical effectiveness of the app, appliance of the app in other fields, and the implications of integration of the app for daily practice in mental health are discussed.
- Published
- 2019