Mental health disorders (MHDs) are the main cause of disability worldwide. Improvements in MHDs are possible with correct treatment, but retention is challenging. Therefore, inexpensive, accessible treatments which aid adherence are critical. One approach is to use a Digital Mental Health Intervention (DMHI). However, sustained use of DMHIs and clinical results have been less positive than hoped. Lack of retention may result from insufficient attention to end-user needs, leading to poor usability. One answer is to include patients with a MHD in a user-centred design (UCD) process. UCD aspires to deliver DMHIs fitting user needs, with the intent of improving engagement, potentially increasing retention and effectiveness.
This research uses UCD to create a User Requirements Document (URD) for a DMHI
delivering Dialectical Behaviour Therapy (DBT) Mindfulness skills, investigating how UCD should be modified for this vulnerable user group. It comprises four studies: a scoping study with non-clinical secondary proxies; a qualitative study of DBT clients' and clinicians' experience of DBT skills training; detailed creation of the URD; and, a Delphi-type study validating the URD with DBT clinicians.
The qualitative study mapped skills training as a journey with five stages; the URD formalised this, and included personas and scenarios. In the validation study, the UX map/scenarios were unproblematic, but personas were polarising. Some clinicians found them representative of clients, others considered mindfulness acquisition portrayal was unrealistic. Following amendments, consensus was reached after two rounds.
This research contributes to knowledge of UCD with users with a life-threatening MHD. Key contributions include analysing the extensive methodological work needed in this challenging context, documenting the necessary UCD amendments, and presenting the benefits and value of such in-depth, demanding work. It provides an important resource for future UCD in difficult, challenging contexts, significantly allowing vulnerable users a voice in the design process.
