Acceptability and Usability of a Digital Behavioral Health Platform for Youth at Risk of Suicide: User-centered Design Study with Patients, Practitioners, and Business Gatekeepers (Preprint)

Abstract

BACKGROUND Youth suicide rates are climbing, underscoring the need to improve clinical care. Personal smartphones can provide an understanding of proximal risk factors associated with suicide and facilitate consistent contact between patients and practitioners to improve treatment engagement and effectiveness. The Vira digital behavior change platform (Vira) consists of a patient smartphone app and a web-based practitioner portal (Vira Pro) that integrates objective mobile sensing data with HIPAA-compliant communication tools. Through Vira, practitioners can continuously assess patients’ real-world behavior and provide clinical tools to enhance treatment via just in time behavior change support. OBJECTIVE To explore the acceptability and usability of the minimal viable product (MVP) version of Vira through a user-centered design (UCD) approach, and to identify barriers to implementing Vira in the context of an adolescent intensive outpatient program. METHODS Over two iterative phases, feedback was gathered from adolescent patients (n=16), mental health practitioners (n=11), and business gatekeepers (n=5). The mixed-methods UCD approach included individual semi-structured interviews (e.g., perspectives on treatment, attitudes towards digital tools), surveys (e.g., usability), and unmoderated user testing sessions (e.g., user experience). RESULTS Overall, participants expressed optimism regarding Vira, particularly among adolescents, who showed high satisfaction with the app’s interface and design. However, clinicians reported more mixed views, agreeing that it would be useful in treatment but also expressing concerns about the volume and displays of patient data in Vira Pro, workload management, and boundaries. Gatekeepers identified usability issues and implementation barriers related to electronic health records but also recognized Vira’s potential to enhance treatment outcomes. Feedback from stakeholders informed several crucial changes to the platform, including adjustments to data sharing protocols, user interface enhancements, and modifications to training methods. CONCLUSIONS Vira has high potential to improve patient engagement and improve clinical outcomes among high-risk youth. Iterative UCD and ongoing stakeholder engagement are essential for developing technology-based interventions that effectively meet the needs of diverse end users and align with clinical workflows. CLINICALTRIAL NA