User-Centered Design of Learn to Quit, a Smoking Cessation Smartphone App for People With Serious Mental Illness

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Abstract

Background

Smoking rates in the United States have been reduced in the past decades to 15% of the general population. However, up to 88% of people with psychiatric symptoms still smoke, leading to high rates of disease and mortality. Therefore, there is a great need to develop smoking cessation interventions that have adequate levels of usability and can reach this population.

Objective

The objective of this study was to report the rationale, ideation, design, user research, and final specifications of a novel smoking cessation app for people with serious mental illness (SMI) that will be tested in a feasibility trial.

Methods

We used a variety of user-centered design methods and materials to develop the tailored smoking cessation app. This included expert panel guidance, a set of design principles and theory-based smoking cessation content, development of personas and paper prototyping, usability testing of the app prototype, establishment of app’s core vision and design specification, and collaboration with a software development company.

Results

We developed Learn to Quit, a smoking cessation app designed and tailored to individuals with SMI that incorporates the following: (1) evidence-based smoking cessation content from Acceptance and Commitment Therapy and US Clinical Practice Guidelines for smoking cessation aimed at providing skills for quitting while addressing mental health symptoms, (2) a set of behavioral principles to increase retention and comprehension of smoking cessation content, (3) a gamification component to encourage and sustain app engagement during a 14-day period, (4) an app structure and layout designed to minimize usability errors in people with SMI, and (5) a set of stories and visuals that communicate smoking cessation concepts and skills in simple terms.

Conclusions

Despite its increasing importance, the design and development of mHealth technology is typically underreported, hampering scientific innovation. This report describes the systematic development of the first smoking cessation app tailored to people with SMI, a population with very high rates of nicotine addiction, and offers new design strategies to engage this population. mHealth developers in smoking cessation and related fields could benefit from a design strategy that capitalizes on the role visual engagement, storytelling, and the systematic application of behavior analytic principles to deliver evidence-based content.

Related collections

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Michael Green, Robert Kern, Robert K. Heaton (2004)

It is generally accepted that cognitive deficits in schizophrenia are related to functional outcome. However, support for longitudinal relationships between cognition and functional outcome has not been as well documented. The current paper presents a review of 18 recently published longitudinal studies (minimum 6-month follow up) of the relationships between cognition and community outcome in schizophrenia. Results from these studies reveal considerable support for longitudinal associations between cognition and community outcome in schizophrenia. These studies demonstrate that cognitive assessment predict later functional outcome and provide a rationale for psychopharmacological interventions for cognitive deficits in schizophrenia. Although the relationships between cognition and community outcome are well-supported, it is clear that community functioning is also affected by a host of factors apart from cognition that are usually not considered in clinical trial studies (e.g., psychosocial rehabilitation and educational/vocational opportunities). In the second part of the paper, we consider intervening steps between cognitive performance measures and community outcome. These steps are apt to have important implications for clinical trials of cognition-enhancing agents in schizophrenia.

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Craig W Colton, Ronald W. Manderscheid (2006)

Introduction Mortality rates are used as global measures of a population's health status and as indicators for public health efforts and medical treatments. Elevated mortality rates among individuals with mental illness have been reported in various studies, but very little focus has been placed on interstate comparisons and congruency of mortality and causes of death among public mental health clients. Methods Using age-adjusted death rates, standardized mortality ratios, and years of potential life lost, we compared the mortality of public mental health clients in eight states with the mortality of their state general populations. The data used in our study were submitted by public mental health agencies in eight states (Arizona, Missouri, Oklahoma, Rhode Island, Texas, Utah, Vermont, and Virginia) for 1997 through 2000 during the Sixteen-State Study on Mental Health Performance Measures, a multistate study federally funded by the Center for Mental Health Services in collaboration with the National Association of State Mental Health Program Directors. Results In all eight states, we found that public mental health clients had a higher relative risk of death than the general populations of their states. Deceased public mental health clients had died at much younger ages and lost decades of potential life when compared with their living cohorts nationwide. Clients with major mental illness diagnoses died at younger ages and lost more years of life than people with non-major mental illness diagnoses. Most mental health clients died of natural causes similar to the leading causes of death found nationwide, including heart disease, cancer, and cerebrovascular, respiratory, and lung diseases. Conclusion Mental health and physical health are intertwined; both types of care should be provided and linked together within health care delivery systems. Research to track mortality and primary care should be increased to provide information for additional action, treatment modification, diagnosis-specific risk, and evidence-based practices.

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While depression is known to involve a disturbance of mood, movement and cognition, its associated cognitive deficits are frequently viewed as simple epiphenomena of the disorder. To review the status of cognitive deficits in depression and their putative neurobiological underpinnings. Selective computerised review of the literature examining cognitive deficits in depression and their brain correlates. Recent studies report both mnemonic deficits and the presence of executive impairment--possibly selective for set-shifting tasks--in depression. Many studies suggest that these occur independent of age, depression severity and subtype, task 'difficulty', motivation and response bias: some persist upon clinical 'recovery'. Mnemonic and executive deficits do no appear to be epiphenomena of depressive disorder. A focus on the interactions between motivation, affect and cognitive function may allow greater understanding of the interplay between key aspects of the dorsal and ventral aspects of the prefrontal cortex in depression.

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Author and article information

Contributors

Roger Vilardaga:

Center for Addiction Science and TechnologyPsychiatry and Behavioral SciencesDuke University2812 Erwin Road, Suite 403 Box 13Durham, NC, 27705United States1 9196813441roger.vilardaga@duke.edu

ORCID: http://orcid.org/0000-0002-7252-4343

Journal

Journal ID (nlm-ta): JMIR Serious Games

Journal ID (iso-abbrev): JMIR Serious Games

Journal ID (publisher-id): JSG

Title: JMIR Serious Games

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2291-9279

Publication date Collection: Jan-Mar 2018

Publication date (Electronic): 16 January 2018

Volume: 6

Issue: 1

Electronic Location Identifier: e2

Affiliations

[1] ¹ Center for Addiction Science and Technology Psychiatry and Behavioral Sciences Duke University Durham, NC United States

[2] ² Design Use Build Department of Human Centered Design and Engineering University of Washington Seattle, WA United States

[3] ³ Department of Psychiatry and Behavioral Sciences University of Washington Seattle, WA United States

[4] ⁴ Chad Otis Illustration & Design Seattle, WA United States

Author notes

Corresponding Author: Roger Vilardaga roger.vilardaga@ 123456duke.edu

Author information

Roger Vilardaga http://orcid.org/0000-0002-7252-4343

Javier Rizo http://orcid.org/0000-0002-7874-0856

Emily Zeng http://orcid.org/0000-0002-0299-5078

Julie A Kientz http://orcid.org/0000-0001-7437-7861

Richard Ries http://orcid.org/0000-0002-3307-6672

Chad Otis http://orcid.org/0000-0001-8049-7309

Kayla Hernandez http://orcid.org/0000-0002-2930-0192

Article

Publisher ID: v6i1e2

DOI: 10.2196/games.8881

PMC ID: 5790963

PubMed ID: 29339346

SO-VID: d79964d4-5b64-4532-b13b-8771d669038f

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Serious Games, is properly cited. The complete bibliographic information, a link to the original publication on http://games.jmir.org, as well as this copyright and license information must be included.

History

Date received : 3 September 2017

Date revision requested : 6 October 2017

Date revision received : 10 November 2017

Date accepted : 25 November 2017

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