Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis

Amy Hardy; Thomas Ward; Richard Emsley; Kathryn Greenwood; Daniel Freeman; David Fowler; Elizabeth Kuipers; Paul Bebbington; Philippa Garety

doi:10.2196/29725

Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis

Amy Hardy^*, Thomas Ward, Richard Emsley, Kathryn Greenwood, Daniel Freeman, David Fowler, Elizabeth Kuipers, Paul Bebbington, Philippa Garety

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the “digital divide.” Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the “digital divide.” SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective: This study explores the “digital divide” and mobile app engagement in the SlowMo randomized controlled trial. Methods: Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results: Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75%, SD 17.1%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions: This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the “digital divide.” Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the “digital divide” on therapy outcomes.

Original language	English
Article number	e29725
Journal	JMIR Human Factors
Volume	9
Issue number	3
DOIs	https://doi.org/10.2196/29725
Publication status	Published - 1 Jul 2022

Keywords

adherence
apps
digital health
engagement
human-centered design
paranoia
psychosis
therapy
user experience

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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@article{258f8fef87e946a4a09581c7f6c83ea4,

title = "Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis",

abstract = "Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the “digital divide.” Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the “digital divide.” SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective: This study explores the “digital divide” and mobile app engagement in the SlowMo randomized controlled trial. Methods: Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results: Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75%, SD 17.1%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions: This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the “digital divide.” Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the “digital divide” on therapy outcomes.",

keywords = "adherence, apps, digital health, engagement, human-centered design, paranoia, psychosis, therapy, user experience",

author = "Amy Hardy and Thomas Ward and Richard Emsley and Kathryn Greenwood and Daniel Freeman and David Fowler and Elizabeth Kuipers and Paul Bebbington and Philippa Garety",

note = "Funding Information: This project was funded by grant 15/48/21 from the Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership (authors: RE, KG, DF, DF, EK, PB, and AH), in part by the NIHR Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust and King's College London (PG and RE); by research professorship NIHR300051 from the NIHR (RE); by research professorship NIHR-RP-2014-05-003 from the NIHR (DF); by grant BRC-1215-20005 from the NIHR Oxford Health Biomedical Research Centre (DF); and by the NIHR Kent, Surrey and Sussex NIHR Applied Research Collaboration (DF). Funding Information: This project was funded by grant 15/48/21 from the Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership (authors: RE, KG, DF, DF, EK, PB, and AH), in part by the NIHR Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust and King{\textquoteright}s College London (PG and RE); by research professorship NIHR300051 from the NIHR (RE); by research professorship NIHR-RP-2014-05-003 from the NIHR (DF); by grant BRC-1215-20005 from the NIHR Oxford Health Biomedical Research Centre (DF); and by the NIHR Kent, Surrey and Sussex NIHR Applied Research Collaboration (DF). Publisher Copyright: {\textcopyright} Amy Hardy, Thomas Ward, Richard Emsley, Kathryn Greenwood, Daniel Freeman, David Fowler, Elizabeth Kuipers, Paul Bebbington, Philippa Garety",

year = "2022",

month = jul,

day = "1",

doi = "10.2196/29725",

language = "English",

volume = "9",

journal = "JMIR Human Factors",

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T1 - Bridging the Digital Divide in Psychological Therapies

T2 - Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis

AU - Hardy, Amy

AU - Ward, Thomas

AU - Emsley, Richard

AU - Greenwood, Kathryn

AU - Freeman, Daniel

AU - Fowler, David

AU - Kuipers, Elizabeth

AU - Bebbington, Paul

AU - Garety, Philippa

N1 - Funding Information: This project was funded by grant 15/48/21 from the Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership (authors: RE, KG, DF, DF, EK, PB, and AH), in part by the NIHR Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust and King's College London (PG and RE); by research professorship NIHR300051 from the NIHR (RE); by research professorship NIHR-RP-2014-05-003 from the NIHR (DF); by grant BRC-1215-20005 from the NIHR Oxford Health Biomedical Research Centre (DF); and by the NIHR Kent, Surrey and Sussex NIHR Applied Research Collaboration (DF). Funding Information: This project was funded by grant 15/48/21 from the Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership (authors: RE, KG, DF, DF, EK, PB, and AH), in part by the NIHR Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust and King’s College London (PG and RE); by research professorship NIHR300051 from the NIHR (RE); by research professorship NIHR-RP-2014-05-003 from the NIHR (DF); by grant BRC-1215-20005 from the NIHR Oxford Health Biomedical Research Centre (DF); and by the NIHR Kent, Surrey and Sussex NIHR Applied Research Collaboration (DF). Publisher Copyright: © Amy Hardy, Thomas Ward, Richard Emsley, Kathryn Greenwood, Daniel Freeman, David Fowler, Elizabeth Kuipers, Paul Bebbington, Philippa Garety

PY - 2022/7/1

Y1 - 2022/7/1

N2 - Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the “digital divide.” Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the “digital divide.” SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective: This study explores the “digital divide” and mobile app engagement in the SlowMo randomized controlled trial. Methods: Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results: Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75%, SD 17.1%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions: This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the “digital divide.” Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the “digital divide” on therapy outcomes.

AB - Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the “digital divide.” Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the “digital divide.” SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective: This study explores the “digital divide” and mobile app engagement in the SlowMo randomized controlled trial. Methods: Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results: Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75%, SD 17.1%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions: This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the “digital divide.” Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the “digital divide” on therapy outcomes.

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KW - apps

KW - digital health

KW - engagement

KW - human-centered design

KW - paranoia

KW - psychosis

KW - therapy

KW - user experience

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ER -

Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis

Abstract

Keywords

UN SDGs

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