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Cited by 46Digital Mental Health InterventionsMobile Health and mHealth ApplicationsUsability and User Interface Design

Development of an Ambulatory Biofeedback App to Enhance Emotional Awareness in Patients with Borderline Personality Disorder: Multicycle Usability Testing Study

Open access
Derks, Youri PMJ, Klaassen, Randy, Westerhof, Gerben J, Bohlmeijer, Ernst T, Noordzij, Matthijs L·2019·JMIR mHealth and uHealth
DOI 10.2196/13479PMC PMC6913718

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Abstract

Background: Patients 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. Objective: The 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. Methods: Using 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). Results: The 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. Conclusions: mHealth 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.

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  • Multiple authors in the included studies indicated that usability tests should be conducted with a broad range of stakeholders, not only end users such as patients, but also caregivers, managers, technology developers, and experts on content and design.

    “First, multiple authors indicated that usability tests should be conducted with a broad range of stakeholders: not only end users such as patients, but also caregivers, managers, technology developers, and experts on content and design”

    From Methods for Human-Centered eHealth Development: Narrative Scoping Review (2022) · cites this paper as [127]

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Research works printed but not linked: 3

  1. [39]Brooke J Jordon PW Thomas B Weerdmeester BA McClelland IL SUS - a quick and dirty usability scale Usability Evaluation in Industry 1996 London CRC Press 189 94
  2. [47]Noordzij ML Scholten P Laroy-Noordzij ME Measuring Electrodermal Activity of Both Individuals With Severe Mental Disabilities and Their Caretakers During Episodes of Challenging Behavior Proceedings of Measuring Behavior 2012, 8th International Conference on Methods and Techniques in Behavioral Research 2012 Measuring Behavior'12 August 28-31, 2012 Utrecht, Netherlands 201 5
  3. [59]van Aken JE Management research based on the paradigm of the design sciences: the quest for field-tested and grounded technological Rules J Manag Stud 2001 2 41 2 - 10.1111/joms.2004.41.issue-2 · DOI

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Authors
Derks, Y. P., Klaassen, R., Westerhof, G. J., Bohlmeijer, E. T., & Noordzij, M. L.
Affiliations
  • GGNet (NL)
  • University of Twente (NL)
Corresponding author
Derks, Youri PMJ
ORCID
Venue
JMIR mHealth and uHealth
Publisher
JMIR Publications Inc.
Published
2019-10-15
Volume
7
Issue
10
Pages
e13479
ISSN
2291-5222 (ISSN-L)
DOI
10.2196/13479
PMC
PMC6913718
OpenAlex
W2964962855
Cited by
45
References
52
Citations by year
2026: 2 · 2025: 5 · 2024: 7 · 2023: 6 · 2022: 11 · 2021: 12 · 2020: 2
FWCI
7.08
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR mhealth and uhealth (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Twente Research Information (publishedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • University of Twente Research Information (submittedVersion, cc-by)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Physical Sciences › Computer Science › Human-Computer Interaction › Usability and User Interface Design
Keywords
borderline personality disorder, emotion regulation, emotional awareness, wearable sensors, mobile health apps, usability testing, user-centered design, mental health services, user experience, therapists, patient acceptance of technology
MeSH terms
Emotional Regulation, Adult, Biofeedback, Psychology, Borderline Personality Disorder, Female, Humans, Ergonomics, Male, Middle Aged, Surveys and Questionnaires, Mobile Applications

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