Romm Kristin Lie, Skoge Mari, Barrett Elizabeth Ann, Berentzen Lars-Christian, Bergsager Dagfinn, Fugelli Pål, Bjella Thomas, Gardsjord Erlend Strand, Kling Kristine, Kruse Sindre Hembre, Kværner Kari Jorunn, Melle Ingrid, Mork Erlend, Ihler Henrik Myhre, Rognli Eline Borger, Simonsen Carmen, Værnes Tor Gunnar, Aminoff Sofie Ragnhild
Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
JMIR Form Res. 2025 Jan 17;9:e57614. doi: 10.2196/57614.
Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges. However, the implementation of digital tools, such as mobile apps, remains limited, and attrition rates for mental health apps are typically high. Design thinking can support the development of tools tailored to the needs of service users and clinicians.
This study aims to develop and beta test a digital tool designed for individuals with severe mental disorders or substance use disorders to facilitate shared decision-making on treatment goals and strategies within mental health services.
We used a user-centered design approach to develop iTandem, an app facilitating collaborative treatment between service users and clinicians. Through qualitative interviews and workshops, we engaged 6 service users with severe mental disorders or substance use disorders, 6 clinicians, and 1 relative to identify and design relevant app modules. A beta test of iTandem was conducted to refine the app and plan for a pilot trial in a clinical setting. After 6 weeks of app use, 5 clinicians and 4 service users were interviewed to provide feedback on the concept, implementation, and technical issues. Safety and ethical considerations were thoroughly discussed and addressed.
To avoid overload for the service users, we applied a pragmatic take on module content and size. Thus, iTandem includes the following 8 modules, primarily based on the needs of service users and clinicians: Sleep (sleep diary), Medication (intake and side effects), Recovery (measures, including well-being and personal recovery, and exercises, including good things and personal strengths), Mood (mood diary and report of daily feelings), Psychosis (level of positive symptoms and their consequences and level of negative symptoms), Activity (goal setting and progress), Substance use (weekly use, potential triggers or strategies used to abstain), and Feedback on therapy (of individual sessions and overall rating of the past week). For the beta testing, service users and clinicians collaborated in choosing 2-3 modules in iTandem to work with during treatment sessions. The testing showed that the app was well received by service users, and that facilitation for implementation is crucial.
iTandem and similar apps have the potential to enhance treatment outcomes by facilitating shared decision-making and tailoring treatment to the needs of service users. However, successful implementation requires thorough testing, iterative development, and evaluations of both utility and treatment effects. There is a critical need to focus on how technology integrates into clinical settings-from development to implementation-and to conduct further research on early health technology assessments to guide these processes.
临床医生与服务使用者之间的共同决策在精神卫生保健中至关重要。实现这一目标的一个重大障碍是缺乏以用户为中心的服务。将数字工具整合到精神卫生服务中有望应对其中一些挑战。然而，数字工具（如移动应用程序）的实施仍然有限，精神卫生应用程序的流失率通常很高。设计思维可以支持开发适合服务使用者和临床医生需求的工具。
本研究旨在开发并进行iTandem数字工具的beta测试，该工具专为患有严重精神障碍或物质使用障碍的个体设计，以促进精神卫生服务中关于治疗目标和策略的共同决策。
我们采用以用户为中心的设计方法来开发iTandem，这是一款促进服务使用者和临床医生之间协作治疗的应用程序。通过定性访谈和研讨会，我们邀请了6名患有严重精神障碍或物质使用障碍的服务使用者、6名临床医生和1名亲属来识别和设计相关的应用程序模块。对iTandem进行了beta测试，以完善该应用程序并为临床环境中的试点试验制定计划。在应用程序使用6周后，对5名临床医生和4名服务使用者进行了访谈，以提供关于概念、实施和技术问题的反馈。对安全和伦理考量进行了充分讨论并加以解决。
为避免服务使用者负担过重，我们对模块内容和大小采取了务实的做法。因此，iTandem包括以下8个模块，主要基于服务使用者和临床医生的需求：睡眠（睡眠日记）、药物治疗（用药情况和副作用）、康复（措施，包括幸福感和个人康复，以及练习，包括好事和个人优势）、情绪（情绪日记和每日感受报告）、精神病症状（阳性症状水平及其后果和阴性症状水平）、活动（目标设定和进展）、物质使用（每周使用情况、潜在触发因素或用于戒除的策略）以及治疗反馈（个别疗程和过去一周的总体评分）。对于beta测试，服务使用者和临床医生合作在iTandem中选择2 - 3个模块在治疗过程中使用。测试表明该应用程序受到服务使用者的好评，并且实施过程中的便利措施至关重要。
iTandem及类似应用程序有潜力通过促进共同决策并根据服务使用者的需求定制治疗来提高治疗效果。然而，成功实施需要进行全面测试、迭代开发以及对效用和治疗效果的评估。迫切需要关注技术如何从开发到实施融入临床环境，并对早期卫生技术评估进行进一步研究以指导这些过程。
