Characterizing User Experiences With an SMS Text Messaging–Based mHealth Intervention: Mixed Methods Study (Preprint)

Abstract

BACKGROUND Limited access to mental health care services due to provider shortages, geographic limitations, and cost has driven the area of mobile health (mHealth) care to address these access gaps. Reports from the Cohen Veterans Network and National Council for Behavioral Health show that in states where mental health care is more accessible, there is still 38% of people who are not receiving the care they need. MHealth strategies help to provide care to individuals experiencing these barriers at lower cost and greater convenience, making mHealth a great resource to bridge the gap. OBJECTIVE We present a mixed-methods study to evaluate user experiences with the mental mHealth service, Cope Notes. Specifically, we aimed to investigate the following research questions: 1. How do Cope Notes users perceive the service as it relates to stigma, impact of the intervention, and perceived usefulness? 2. How do Cope Notes users rate the Cope Notes service and messaging along various dimensions of acceptability? 3. What is the relationship between Cope Notes message ratings and user personality and coping strategies? 4. What are user perspectives of ubiquitous sensing technologies, including integration of ubiquitous sensing for the improvement in timeliness of the intervention and quality of tailored content? METHODS We performed qualitative interviews with Cope Notes users (n=14) who have used the service for at least 30 days to evaluate their experience and usefulness of the service. These interviews were coded by two raters, and interrater reliability was calculated with SPSS at 61.8%. Additionally, participants completed quantitative measures, including a user experiences survey, personality inventory (Big Five-10), and coping assessment (Brief COPE). RESULTS We derived seven main overarching themes from our qualitative interviews: Likes/Perceived Benefits, Dislikes/Limitations, Suggested Changes, Stigma/Help Seeking, Perceptions of Ubiquitous Sensing, Cultural Sensitivity, and Alternative mHealth Resources. Exploratory analyses between acceptability ratings of Cope Notes and personality factors from BF-10 yielded statistically significant positive relationships between seeing oneself as someone who is generally trusting and various acceptability items, the most significant being item 7 (“I fully understood the sentiment behind Cope Notes Messages”) with (rs(10) = 0.82, P = .001). We also found statistically significant relationships between the acceptability items and Brief COPE items, with the strongest positive correlation between participants strongly endorsing coping by accepting the reality that an event has happened and acceptability item 7 (rs(8) = 0.86, P = .001). CONCLUSIONS Our study found that Cope Notes subscribers appreciate the service for reframing and refocusing their mental wellness with statistically significant correlations between personality and the acceptability of the service. We found that some users prefer a more personalized experience with neutral to positive reactions to a potential companion app that continuously monitors user behavior via smartphone sensor readings to provide just-in-time interventions when users need it the most.