Online Support and Intervention for Child Anxiety (OSI): Development and Usability Testing

Hill, Claire; Reardon, Tessa; Taylor, Lucy; Creswell, Cathy

doi:10.2196/29846

Cited by 43Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesUsability and User Interface Design

Online Support and Intervention for Child Anxiety (OSI): Development and Usability Testing

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Hill, Claire, Reardon, Tessa, Taylor, Lucy, Creswell, Cathy·2022·JMIR Formative Research

DOI 10.2196/29846PMC PMC9047721

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Abstract

Background: Internet-based treatments for child anxiety may help to increase access to evidence-based therapies; however, user engagement, uptake, and adherence within routine clinical practice remain as challenges. Involving the intended end users in the development process through user-centered design and usability testing is crucial for maximizing user engagement and adoption of internet-based treatments, but so far this has been lacking for internet-based treatments for child anxiety. Objective: The aim of this study is to develop an internet-based treatment for child anxiety through a process of user-centered design (phase 1) and usability testing (phase 2), based on an existing evidence-based, face-to-face, therapist-supported, parent-led cognitive behavioral therapy intervention. It is intended that the internet-based version of this treatment would consist of a parent website, case management system for clinicians, and mobile game app for children. Methods: Parents, children, and clinicians who were familiar with the face-to-face version of the treatment were recruited from 2 National Health Service clinics. In phase 1, participants participated in 3 workshops to gain feedback on the overall concept, explore their wants and needs for the websites and game, generate ideas on how the treatment may look, and gain feedback on initial mock-ups of the websites and game. In phase 2, participants attended 3 individual usability testing sessions where they were presented with working prototypes of the website or game and asked to perform a series of tasks on the website (parents and clinicians) or play the game (children). The frequency and details on usability errors were recorded. Participants were asked for their feedback on the website and game using a standardized usability questionnaire and semistructured interviews. The websites and game were iterated after each round of usability testing in response to this feedback. Results: In phase 1, participants approved the general concept and rated the initial mock-ups of the website and game positively. In phase 2, working prototypes were rated positively and usability errors declined across the iterations and were mainly cosmetic or minor issues relating to esthetic preference, with few issues regarding ability to navigate the website or technical issues affecting functionality. Feedback from the semistructured interviews further supported the positive response of participants to the website and game, and helped identify areas for improvement during the iteration process. The final iteration of the website and game are presented. Conclusions: Taking an iterative approach to development through user-centered design and usability testing has resulted in an internet-based treatment for child anxiety (Online Support and Intervention for child anxiety) that appears to meet the needs and expectations of the intended users (parents, children, and clinicians) and is easy and enjoyable to use.

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Previous studies with participatory approaches when developing CBT interventions for youth anxiety have primarily focused on digital interventions.
“When developing CBT interventions for youth anxiety, previous studies with participatory approaches have primarily been focused on digital interventions [18–23].”
From Developing a primary care-based cognitive behavioral intervention for anxiety in children through a participatory approach: a qualitative study. (2026) · cites this paper as [20]

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Authors: Hill, C., Reardon, T., Taylor, L., & Creswell, C.
Affiliations: University of Reading (GB)
University of Oxford (GB)
Corresponding author: Hill, Claire
ORCID: Hill, Claire
Reardon, Tessa
Taylor, Lucy
Creswell, Cathy
Venue: JMIR Formative Research
Publisher: JMIR Publications Inc.
Published: 2022-04-13
Volume: 6
Issue: 4
Pages: e29846
ISSN: 2561-326X (ISSN-L)
DOI: 10.2196/29846
PMC: PMC9047721
OpenAlex: W4223487014
Cited by: 43
References: 56
Citations by year: 2026: 7 · 2025: 8 · 2024: 8 · 2023: 8 · 2022: 12
FWCI: 7.95
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: JMIR Formative Research (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
CentAUR (University of Reading) (acceptedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders: National Institute for Health and Care Research (RP_2014-04-018, NIHR201370)
Department of Health and Social Care
Topics: Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Physical Sciences › Computer Science › Human-Computer Interaction › Usability and User Interface Design
Keywords: online therapy, internet-based cognitive behavioral therapy, parent-led intervention, user-centered design, usability testing, case management systems, user engagement, iterative development

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Online Support and Intervention for Child Anxiety (OSI): Development and Usability Testing

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