A Web-Based Application for Personalized Ecological Momentary Assessment in Psychiatric Care: User-Centered Development of the PETRA Application

Abstract

Background: Smartphone self-monitoring of mood, symptoms, and contextual factors through ecological momentary assessment (EMA) provides insights into the daily lives of people undergoing psychiatric treatment. Therefore, EMA has the potential to improve their care. To integrate EMA into treatment, a clinical tool that helps clients and clinicians create personalized EMA diaries and interpret the gathered data is needed.

Objective: This study aimed to develop a web-based application for personalized EMA in specialized psychiatric care in close collaboration with all stakeholders (ie, clients, clinicians, researchers, and software developers).

Methods: The participants were 52 clients with mood, anxiety, and psychotic disorders and 45 clinicians (psychiatrists, psychologists, and psychiatric nurses). We engaged them in interviews, focus groups, and usability sessions to determine the requirements for an EMA web application and repeatedly obtained feedback on iteratively improved high-fidelity EMA web application prototypes. We used human-centered design principles to determine important requirements for the web application and designed high-fidelity prototypes that were continuously re-evaluated and adapted.

Results: The iterative development process resulted in Personalized Treatment by Real-time Assessment (PETRA), which is a scientifically grounded web application for the integration of personalized EMA in Dutch clinical care. PETRA includes a decision aid to support clients and clinicians with constructing personalized EMA diaries, an EMA diary item repository, an SMS text message-based diary delivery system, and a feedback module for visualizing the gathered EMA data. PETRA is integrated into electronic health record systems to ensure ease of use and sustainable integration in clinical care and adheres to privacy regulations.

Conclusions: PETRA was built to fulfill the needs of clients and clinicians for a user-friendly and personalized EMA tool embedded in routine psychiatric care. PETRA is unique in this codevelopment process, its extensive but user-friendly personalization options, its integration into electronic health record systems, its transdiagnostic focus, and its strong scientific foundation in the design of EMA diaries and feedback. The clinical effectiveness of integrating personalized diaries via PETRA into care requires further research. As such, PETRA paves the way for a systematic investigation of the utility of personalized EMA for routine mental health care.

Keywords: client-tailored; clinical implementation; cocreation; eHealth; ecological momentary assessment; experience sampling method; mHealth; mobile health; mobile phone; personalized diaries; personalized psychiatry; shared decision-making; smartphone.

Figure 1

Overview of the developmental phases of PETRA (Personalized Treatment by Real-time Assessment). EMA: ecological momentary assessment.

Figure 2

The first wireframe that was designed of the first page of the decision aid, on which participants select the goal of the EMA diary. The usability sessions indicated a need for an introduction and a more detailed progress menu. More detailed wireframes can be found here [41]. EMA: ecological momentary assessment.

Figure 3

The ninth wireframe that was designed of the first page of the decision aid, on which participants select the goal of the EMA diary. As suggested in usability sessions, it incorporates an introduction and a more detailed progress menu. More detailed wireframes can be found here [41]. EMA: ecological momentary assessment.

Figure 4

The final (visual) design of the first page of the decision aid, on which participants select the goal of the EMA diary. More detailed wireframes can be found here [41]. EMA: ecological momentary assessment.

Figure 5

Overview of PETRA.

Figure 6

An interactive graph on the variation in mood and symptoms in the feedback module. All continuous ecological momentary assessment (EMA) diary items can be selected from the menu on the right side of the screen. Clicking on any of the assessment points will activate a sliding pane depicted in Figure 7. For a video, see here [49].

Figure 7

Sliding panel in the feedback module that provides relevant contextual information for a specific moment in the time series and surrounding moments. Moments are selected by clicking on assessment points in the graph depicted in Figure 6. For a video, see here [49].

Figure 8

A word cloud of all freely entered text in the feedback module. Clicking on a word provides more context on when this word was used. For a video, see here [49].