Mobile Mental Health Technologies: Unique Challenges and Solutions for an effective User Centered Design Methodology
Authors: Johnson Amanda J. , Bisantz Ann M. , Reynolds Amy L. , Meier Scott T. 
Published: November 2019

Mobile technologies are rapidly becoming a tool for collaborative health care and increasing access to health information and treatment. Mental health is one area of healthcare that may be particularly suited to mobile health technologies because of barriers including insufficient numbers of providers and access concerns such as lack of insurance coverage. Previous research has found that many people are interested in utilizing mobile health technologies for mental health (Shand, Ridani, Tighe, & Christensen, 2013; McManama, LeCloux, Ross, Gironda, & Wharff, 2017; Pauwels et al., 2017). Many mental health applications currently available have been found to be unengaging, difficult to use, and some may even be detrimental to the user (Aguirre, McCoy, & Roan, 2013; Larsen, Nicholas, and Christensen, 2016). Research has also shown that traditional usability standards and guidelines for design do not apply to persons with mental health concerns (Rotondi, et al., 2007). The most effective way to develop mobile applications for mental health that are both effective and user friendly is to take a user centered design approach incorporating those with mental health issues into the design process. One barrier to this has been the perception that those with mental health concerns are incapable of participating in research or that it may be harmful for them to do so. More recent research has shown that not only is it possible for those with even severe mental health issues to participate in research, but that it can be beneficial to those participants (Gibson, Boden, Benson, & Brand, 2014; Hutchinson, Wilson, & Wilson 1994, Biddle, et al., 2013). Involving individuals with mental health concerns in application development has become increasingly prevalent and important, thus making it appropriate to consider, the special needs of the population and the potential adaptations that may need to be made to traditional research protocols and user centered design methods. Population While the population of those with mental health concerns is as diverse as the general population at large, certain characteristics are over-represented in the population of those with mental health concerns. These can include a lower than average amount of education, lower socio-economic status, and diminished cognitive functioning (Yu and Williams, 1999; Vick, Jones, & Mitra, 2012, Rock, Rosier, Riedel, & Blackwell, 2014). These characteristics can impact participation in usability research in several ways that necessitate adaptations to commonly used design methods and research practices. Additionally, due to the high levels of stigma and increased needs for privacy present with this population further considerations are warranted. Methods Recommended adaptations include both adaptations to the overall research protocol as well as those pertaining to specific methods. One example of an adaptation to the overall research protocol is a reduced expectation for duration and frequency of participation because of decreased frustration tolerance related to mental health concerns (Ellis, Vanderlind, & Beevers 2013). Another example would be adjustments to the consent process such as ongoing assessment of ability to consent (Tee & Lathlean, 2004) due to changes in intensity of mental health symptomology. Other general considerations include use of collaborative and culturally sensitive language (Kelly, Wakeman, & Saitz, 2015; Granello & Gibbs, 2016; Bonevski, et al. 2014), avoiding the use of content that may be insensitive or may unnecessarily exacerbate symptoms, (Bonevski, et al., 2014), and paying attention to the layout and content of study materials so as to meet the need of those who are experiencing cognitive difficulties resulting from their mental health symptoms (Friedman and Bryen, 2007; Rotondi, et al., 2013, and Rotondi, et al., 2007). An example of an adaptation more specific to method would be considering one on one interview instead of a focus group due to increased privacy concerns and potential for anxiety related to disclosing in groups. Conclusion Taking into consideration the unique needs of the population of those with mental health concerns will allow for the design of applications that better serve them. This will improve the utility, accessibility, and propagation of such applications and has the potential to both improve existing services and to expand access. Acknowledgements: We would like to acknowledge Capstone Behavioral Healthcare for their ongoing support of usability research with those with mental health concerns.