A Mobile Intervention to Reduce Anxiety Among University Students, Faculty, and Staff: Mixed Methods Study on Users’ Experiences
Authors: Livermon Sarah , Michel Audrey , Zhang Yiyang , Petz Kaitlyn , Toner Emma , Rucker Mark , Boukhechba Mehdi , Barnes Laura E. , Teachman Bethany A. 
Published: August 2024

Anxiety is highly prevalent among college communities, with significant numbers of students, faculty, and staff experiencing severe anxiety symptoms. Despite this high prevalence, many individuals remain untreated due to barriers such as time, stigma, waitlists, and cost of services. Digital mental health interventions (DMHIs), including Cognitive Bias Modification for Interpretation (CBM-I), offer promising solutions to enhance access to mental health care, yet there is a critical need to evaluate user experience and acceptability of DMHIs. This study used a mixed methods approach to gather feedback from users of the first trial of a mobile application called “Hoos Think Calmly” (HTC), which offers brief CBM-I training to reduce negative interpretations and increase flexible thinking in response to stressors commonly experienced by students, faculty, and staff at a large public university. Following the parent trial (https://osf.io/36grh/) qualitative data was collected through semi-structured interviews from a subset of participants (n=22). Thematic analysis revealed five main themes: Effectiveness of the Training Program; Feedback on Training Sessions; Barriers to Using the App; Use Patterns; and Suggestions for Improvement. Feedback highlighted the importance of greater content relatability and personalization, while also identifying forgetfulness and not understanding the intervention format or rationale as barriers to using the program. Participants tended to use the program at routine or scheduled times rather than during specific moments of stress or anxiety and relied heavily on the app’s notification system. Suggestions for improvement focused on incorporating progress tracking, offering greater customization options, and integrating more diverse training content. Additionally, biweekly user experience questionnaires sent to all participants in the active treatment condition (n=134) during the parent trial showed most participants reported the program to be slightly to somewhat helpful in reducing or managing their anxiety or stress. Findings highlight the importance of understanding users’ experience and iterative DMHI development.

Author Summary

Effective digital mental health interventions can help address the high levels of reported anxiety in college communities. These interventions can be used to reduce the barriers to accessing mental health services and promote flexible thinking to reduce the harmful impacts of anxiety. Despite evidence supporting the effectiveness of various DMHIs, their impact is often hindered by high attrition rates alongside low engagement. In this study, we gathered mixed-methods feedback data on a new DMHI called Hoos Think Calmly to assess individual user experiences that may impact engagement. Our goal is to better understand participants’ evaluation of HTC and to gather feedback on how to enhance acceptability of the program in future iterations. Data was collected through feedback interviews and user experience questionnaires. We found that participants perceived HTC to be somewhat effective at reducing or managing their anxiety, but also noted barriers to ongoing use. Our study provides helpful insights into app use patterns, barriers to engagement, and general suggestions for improving DMHIs.