eHealth, Health Communication, Mental Health , , , , ,

Are Mobile Mental Health Apps User-Friendly?

by Kat Caskey

Currently, only about half of those affected by mental illness in the United States will receive any kind of treatment[1]. In the past few years, however, experts have begun to look to remote healthcare options that could improve access to mental health treatment. Perhaps most promising is the growing consensus that mental health apps, or mHealth apps, “have unprecedented potential for improving quality of life and public health outcomes” for the tens of millions of people affected by mental health conditions in the U.S. each year.[2]

Mobile apps have the unique potential to reduce many of the traditional barriers to mental health treatment. For example, mHealth apps can be significantly less expensive than traditional treatment and may be accessed anytime, including during times of crisis, without an appointment. In addition, apps can reduce cultural barriers to care as they provide a “discrete mobile environment” free from social stigma.[3]

Evidence-based mHealth apps have been proven effective at treating a variety of mental health conditions, including posttraumatic stress disorder[4], anxiety[5], depression[6], obsessive compulsive disorder[7], bipolar disorder, borderline personality disorder, and substance abuse[8]. Unfortunately, however, although patients frequently download any of the myriad of mental health apps available in the App store, many are deleted after only a few uses, and a staggering 26% are used only once. One study that surveyed mental health app users found that among the most common reasons for deleting mental health apps included “not engaging” and “not user friendly,” with “ease of navigation” being the top feature that makes eHealth apps for mental health favorable.[9]

What good are evidence-based mental health apps if people won’t use them? These results indicate trouble in the realm of user experience, which considers “user emotions, affects, motivations, and values” as well as “ease of use, ease of learning and basic subjective satisfaction.”[10] Understanding user experience has been identified as “a key step in realizing the role of mental health apps”[11] and reminds us that it is not enough to understand the clinical basis of new health technologies; equally significant is consideration of the best ways to design and implement apps for people with mental health conditions. Ideally, user experience and usability testing evaluations should involve all relevant stakeholders, including patients and providers.[12]

Especially considering the wide reach of mHealth apps, “even minor efforts to further refine the usability and utility of the app” have the potential to decrease app attrition rates and increase user exposure to evidence-based treatment recommendations.[13] As apps designed to improve mental health continue to proliferate, app designers and researchers should continue to investigate how an emphasis on user experience can improve mHealth tools for mental health.

[1] National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/index.shtml.  Accessed February 4, 2018.

[2] Owen, J. E., Jaworski, B. K., Kuhn, E., Makin-Byrd, K. N., Ramsey, K. M., & Hoffman, J. E. (2015). mHealth in the wild: using novel data to examine the reach, use, and impact of PTSD coach. JMIR mental health2(1).

[3] Owen, J. E., Jaworski, B. K., Kuhn, E., Makin-Byrd, K. N., Ramsey, K. M., & Hoffman, J. E. (2015). mHealth in the wild: using novel data to examine the reach, use, and impact of PTSD coach. JMIR mental health2(1).

[4]Rodriguez-Paras, C., Tippey, K., Brown, E., Sasangohar, F., Creech, S., Kum, H. C., … & Benzer, J. K. (2017). Posttraumatic Stress Disorder and Mobile Health: App Investigation and Scoping Literature Review. JMIR mHealth and uHealth5(10).;
Owen, J. E., Jaworski, B. K., Kuhn, E., Makin-Byrd, K. N., Ramsey, K. M., & Hoffman, J. E. (2015). mHealth in the wild: using novel data to examine the reach, use, and impact of PTSD coach. JMIR mental health2(1).

[5] Sucala, M., Cuijpers, P., Muench, F., Cardoș, R., Soflau, R., Dobrean, A., … & David, D. (2017). Anxiety: There is an app for that. A systematic review of anxiety apps. Depression and anxiety.

[6] Lattie, E. G., Schueller, S. M., Sargent, E., Stiles-Shields, C., Tomasino, K. N., Corden, M. E., … & Mohr, D. C. (2016). Uptake and usage of IntelliCare: a publicly available suite of mental health and well-being apps. Internet interventions4, 152-158.

[7] Ameringen, M., Turna, J., Khalesi, Z., Pullia, K., & Patterson, B. (2017). There is an app for that! The current state of mobile applications (apps) for DSM‐5 obsessive‐compulsive disorder, posttraumatic stress disorder, anxiety and mood disorders. Depression and anxiety.

[8] Rizvi, S. L., Dimeff, L. A., Skutch, J., Carroll, D., & Linehan, M. M. (2011). A pilot study of the DBT coach: an interactive mobile phone application for individuals with borderline personality disorder and substance use disorder. Behavior therapy42(4), 589-600.

[9] Smith, D. Motivating Patients to use Smartphone Health Apps. Consumer Health Information Corporation. http://www.consumer-health.com/motivating-patients-to-use-smartphone-health-apps/. Published 2014. Accessed February 4, 2018.

[10] Abrahão, S., Bordeleau, F., Cheng, B., Kokaly, S., Paige, R. F., Störrle, H., & Whittle, J. (2017, September). User Experience for Model-Driven Engineering: Challenges and Future Directions. In 2017 ACM/IEEE 20th International Conference on Model Driven Engineering Languages and Systems (MODELS) (pp. 229-236). IEEE.

[11] Lemon, Christopher. “The User Experience: A Key Step in Realizing the Role of Mental Health Apps.” Psychiatric Times, 7 Feb. 2018, www.psychiatrictimes.com/telepsychiatry/user-experience-key-step-realizing-role-mental-health-apps.

[12] Price, M., Yuen, E. K., Goetter, E. M., Herbert, J. D., Forman, E. M., Acierno, R., & Ruggiero, K. J. (2014). mHealth: a mechanism to deliver more accessible, more effective mental health care. Clinical psychology & psychotherapy21(5), 427-436.

[13] Owen, J. E., Jaworski, B. K., Kuhn, E., Makin-Byrd, K. N., Ramsey, K. M., & Hoffman, J. E. (2015). mHealth in the wild: using novel data to examine the reach, use, and impact of PTSD coach. JMIR mental health2(1).