Development and preliminary testing of a web-based, self-help application for disaster-affected families

Technology-based self-help interventions have the potential to increase access to evidence-based mental healthcare, especially for families affected by natural disasters. However, development of these interventions is a complex process and poses unique challenges. Usability testing, which assesses the ability of individuals to use an application successfully, can have a significant impact on the quality of a self-help intervention. This article describes (a) the development of a novel web-based multi-module self-help intervention for disaster-affected adolescents and their parents and (b) a mixed-methods formal usability study to evaluate user response. A total of 24 adolescents were observed, videotaped, and interviewed as they used the depressed mood component of the self-help intervention. Quantitative results indicated an above-average user experience, and qualitative analysis identified 120 unique usability issues. We discuss the challenges of developing self-help applications, including design considerations and the value of usability testing in technology-based interventions, as well as our plan for widespread dissemination.

[1]  Jacqueline L Stoddard,et al.  The importance of usability testing in the development of an internet-based smoking cessation treatment resource. , 2006, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[2]  M. Elliott,et al.  A National Longitudinal Study of the Psychological Consequences of the September 11, 2001 Terrorist Attacks: Reactions, Impairment, and Help-Seeking , 2004, Psychiatry.

[3]  J. M. Furr,et al.  Disasters and youth: a meta-analytic examination of posttraumatic stress. , 2010, Journal of consulting and clinical psychology.

[4]  G. Andersson,et al.  Internet-based self-help for depression: randomised controlled trial , 2005, British Journal of Psychiatry.

[5]  A. Papa,et al.  A randomized, controlled proof-of-concept trial of an Internet-based, therapist-assisted self-management treatment for posttraumatic stress disorder. , 2007, The American journal of psychiatry.

[6]  Elizabeth G Eakin,et al.  Randomized trial of a neighborhood environment-focused physical activity website intervention. , 2009, Preventive medicine.

[7]  Jackie K. Gollan,et al.  A component analysis of cognitive-behavioral treatment for depression , 1996 .

[8]  C. Lejuez,et al.  Application of Behavioral Activation Treatment for Depression to an Adolescent With a History of Child Maltreatment , 2007 .

[9]  Kathleen M Griffiths,et al.  A Comparison of Changes in Anxiety and Depression Symptoms of Spontaneous Users and Trial Participants of a Cognitive Behavior Therapy Website , 2004, Journal of medical Internet research.

[10]  E. Deblinger,et al.  Treating Sexually Abused Children And Their Nonoffending Parents: A Cognitive Behavioral Approach , 1996 .

[11]  N. Rüsch,et al.  What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies , 2014, Psychological Medicine.

[12]  Holly Barrett Waldron,et al.  On the learning curve: the emerging evidence supporting cognitive-behavioral therapies for adolescent substance abuse. , 2004, Addiction.

[13]  N. Titov,et al.  Clinician-Assisted Internet-Based Treatment is Effective for Panic: A Randomized Controlled Trial , 2009, The Australian and New Zealand journal of psychiatry.

[14]  J. Seeley,et al.  Methodological Issues in Research on Web-Based Behavioral Interventions , 2009, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[15]  Froma Walsh,et al.  Normal family processes : growing diversity and complexity , 2003 .

[16]  Britt Klein,et al.  A Therapist‐Assisted Internet‐Based CBT Intervention for Posttraumatic Stress Disorder: Preliminary Results , 2009, Cognitive behaviour therapy.

[17]  Kyleen E. Welsh,et al.  Bounce Back Now! Protocol of a population-based randomized controlled trial to examine the efficacy of a Web-based intervention with disaster-affected families. , 2015, Contemporary clinical trials.

[18]  Charles Wenar,et al.  Developmental Psychopathology from Infancy through Adolescence , 1994 .

[19]  D. Bowen,et al.  Adaptation of a Smoking Cessation and Prevention Website for Urban American Indian/Alaska Native Youth , 2010, Journal of Cancer Education.

[20]  Ganie DeHart,et al.  Child Development: Its Nature and Course , 1988 .

[21]  R. Kadden,et al.  Motivational Enhancement Therapy and Cognitive Behavioral Therapy for Adolescent Cannabis Users: 5 Sessions (Cannabis Youth Treatment (Cyt) Series) - Volume 1. , 2013 .

[22]  Kerry Mummery,et al.  Applying usability testing techniques to improve an interactive physical activity website: The case of 10,000 steps , 2006 .

[23]  R. Steer,et al.  Manual for the Beck Anxiety Inventory. , 2013 .

[24]  Helen Christensen,et al.  Internet‐based interventions for young people with problematic substance use: a systematic review , 2010, The Medical journal of Australia.

[25]  Kara L. Hall,et al.  Research Dissemination and Diffusion , 2009 .

[26]  Leslie Lenert,et al.  Implementation Brief: Design and Pilot Evaluation of an Internet Smoking Cessation Program , 2003, J. Am. Medical Informatics Assoc..

[27]  A. Beck,et al.  An inventory for measuring clinical anxiety: psychometric properties. , 1988, Journal of consulting and clinical psychology.

[28]  N. Titov,et al.  Clinician-Assisted Internet-Based Treatment is Effective for Depression: Randomized Controlled Trial , 2009, The Australian and New Zealand journal of psychiatry.

[29]  A. Michael Huberman,et al.  An expanded sourcebook qualitative data analysis , 1994 .

[30]  D. Charney,et al.  The development of a Clinician-Administered PTSD Scale , 1995, Journal of traumatic stress.

[31]  Harry Budi Santoso,et al.  Measuring the user experience , 2008 .

[32]  Chris Kelleher,et al.  Overcoming Depression on the Internet (ODIN) (2): A Randomized Trial of a Self-Help Depression Skills Program With Reminders , 2005, Journal of medical Internet research.

[33]  Heidi Zinzow,et al.  Internet-based interventions for traumatic stress-related mental health problems: a review and suggestion for future research. , 2009, Clinical psychology review.

[34]  Erica K. Yuen,et al.  Challenges and Opportunities in Internet-Mediated Telemental Health , 2012 .

[35]  K. Charmaz.  Constructivist-Grounded Theory , 2008 .

[36]  B MilesMatthew,et al.  Qualitative Data Analysis , 2009, Approaches and Processes of Social Science Research.

[37]  R. Rapee,et al.  Family treatment of childhood anxiety: a controlled trial. , 1996, Journal of consulting and clinical psychology.

[38]  H. Christensen,et al.  Review of internet‐based prevention and treatment programs for anxiety and depression in children and adolescents , 2010, The Medical journal of Australia.

[39]  C. Lejuez,et al.  Contemporary behavioral activation treatments for depression: procedures, principles, and progress. , 2003, Clinical psychology review.

[40]  Frank C Verhulst,et al.  The effect of a severe disaster on the mental health of adolescents: a controlled study , 2003, The Lancet.

[41]  A. Bauman,et al.  Engagement and retention of participants in a physical activity website. , 2005, Preventive medicine.

[42]  L. Berkman,et al.  Two Shorter Forms of the CES-D Depression Symptoms Index , 1993 .