Development of a Mobile App for Suicide Prevention Using Ecological Momentary Assessment and Interventions Based on a Software Development Life Cycle (Preprint)
Authors: Jeong Hyunwoo , Kim Heeyeon , Jeon Yoojin , Kim Heejung 
Published: February 2024

BACKGROUND

Suicide prevention is an important global public health issue. Ecological momentary interventions (EMI) via mobile device applications (apps) have been developed to target the digital native generation who actively uses smartphones and in-phone apps for lifestyle and health care.

OBJECTIVE

This study developed a mobile app called eRAPPORT, based on ecological momentary assessment (EMA) and EMI to prevent suicide among high-risk adults. In addition, we provide detailed documentation of the development process and described specific strategies based on our lived experiences.

METHODS

A software development life cycle was used as a methodological framework in developing eRAPPORT. We first identified the current status of suicide-related apps by conducting a literature review and mobile app market search for mHealth suicide programs. The design of eRAPPORT and its content were then developed through the collaboration of contextual and methodological experts. For implementation, a mobile app development company closely worked with us throughout the development process. Participants were asked to use eRAPPORT for a 1-month trial and complete a self-reported questionnaire on app usability (Weeks 2 and 4). Descriptive statistics was used to express quantitative data. In-depth interviews (Week 4) were conducted to discussed the experience of using the app.

RESULTS

The eRAPPORT integrated a safety plan, tracking of suicidal ideation and other mental health indicators, evidence-based information and other Korean resources on suicide prevention, referrals for online/offline counseling, emergency contacts, technical support, and a Q & A section covering mental health concerns. Furthermore, eRAPPORT was designed to highlight contextual and methodological considerations, such as (1) concise and intuitive visualization of the frame and functions to prevent user fatigue, considering the user’s low level of physical and emotional energy; (2) evidence-based mood-tracking assessment and relevant information, including valid and reliable instruments, national guidelines for suicide prevention, and recently published literature; and (3) activation of timely help based on individualized pattern of mood and suicidal ideation rather than passive one-way education. App usability scored 62.61 ± 14.76 on the System Usability Scale and 69.16 ± 15.32 on the Client Satisfaction Questionnaire. Users stated that eRAPPORT helped prevent suicide and was intuitive to use.

CONCLUSIONS

This methodological and feasibility study provides a detailed report of the software development process and usability of the eRAPPORT app. EMA and EMI enable us to collect real time and longitudinal data to monitor mental health and suicide risk in adults living in the community. Most users evaluated that the app contents and modalities are very helpful and satisfactory; however, improvements can still be made to enhance user adherence and satisfaction. The eRAPPORT app can serve as a platform for collecting real-world population data to develop a data-driven algorithm for screening and monitoring individuals at high-risk for suicide.

CLINICALTRIAL

No