A Narrative Review of Methods for Applying User Experience in the Design and Assessment of Mental Health Smartphone Interventions

Abstract

ObjectivesUser experience (UX) plays a key role in uptake and usage of mental health smartphone interventions, yet remains underinvestigated. This review aimed to characterize and compare UX evaluation approaches that have been applied in this specific context, and to identify implications for research and practice.MethodsA narrative review was conducted of UX-themed studies published in PubMed, PsycINFO, and Scopus up to February 2019. Eligible studies reported on data reflecting users' interactions with a smartphone intervention for any mental health condition. Studies were categorized into “situated” versus “construct-based” methods according to whether or not an established UX construct was used to acquire and analyze data.ResultsSituated approaches used bespoke UX metrics, including quantitative measures of usage and performance, as well as grounded interview data. Construct-based approaches such as assessments of usability and acceptability were based on conceptual frameworks, with methodologically stronger versions featuring construct definitions, validated measurement tools, and an ability to compare data across studies. Constructs and measures were sometimes combined to form bespoke construct-based approaches.ConclusionsBoth situated and construct-based UX data may provide benefits during design and implementation of a mental health smartphone intervention by helping to clarify the needs of users and the impact of new features. Notable however was the omission of UX methods, such as split testing. Future research should consider these unaddressed methods, aim to improve the rigor of UX assessment, integrate their use alongside clinical outcomes, and explore UX assessment of more complex, adaptive interventions.

Leveraging Implementation Science to Understand Factors Influencing Sustained Use of Mental Health Apps: a Narrative Review

“…As the field matures, there have been increasing calls to incorporate design thinking strategies and user experience testing into MH app development (Lemon et al 2020 ). Apps should be simple, allowing users to engage with them in short bursts versus requiring long stretches of sustained attention (Zhang et al 2019 ); indeed, MH apps designed for briefer interactions demonstrated higher engagement rates (Firth et al 2017a ).…”

“…Apps need to aggregate potentially large amounts of patient data into a quickly interpretable form for this information to be of any use to providers. If the process of accessing patient app information is not seamlessly integrated into providers’ hectic workflows, it will be difficult to see buy-in at this level (Gordon et al 2020 ; Jacob et al 2020 ; Lemon et al 2020 ).…”

“…Providers’ values, beliefs, and motivation are also critical to consider; providers must believe that an app will significantly benefit their patient for them to recommend one (Jacob et al 2020 ). Providers may feel that apps can improve patient self-management and facilitate communication; however, they may also think that apps are impersonal, contain unreliable information, or do not have proper privacy regulations (Jacob et al 2020 ; Lattie et al 2020 ; Lemon et al 2020 ). This skepticism may understandably impact providers’ motivation to recommend apps.…”

“…This narrative review is not meant to be exhaustive but to highlight timely and relevant MH app research (Grant and Booth 2009 ). Narrative reviews are well suited to examine broader research questions that may span disciplines and source types; they differ from systematic reviews in that the search strategy is not fully comprehensive and the selection criteria are less restrictive, allowing a wider breadth of sources to be represented (Cook et al 1997 ; see Lemon et al ( 2020 ) and Hidalgo-Mazzei et al ( 2020 ) for examples of additional MH app narrative reviews). Given the speed of app innovation, articles published more than 5 years ago could be outdated; therefore, we searched for studies published between 2015 and 2020, with a preference towards those published in the last 2 years.…”

The effect of user interface on treatment engagement in a self-guided digital problem-solving intervention: A randomized controlled trial

“…It has been suggested that an optimized user interface (UI), that takes user experience (UX) into account, should be beneficial for the engagement with digital mental health interventions ( Lemon et al, 2020 ). When aiming for enhanced UX, it has been suggested that it is vital to apply design principles that make the UI simple and intuitive to use, in order to facilitate user engagement ( Bakker et al, 2016 ; Chandrashekar, 2018 ; Lemon et al, 2020 ).…”