Development of a smartphone app to predict and improve rates of suicidal ideation among transgender persons (TransLife): A Qualitative study (Preprint)

BACKGROUND Transgender people are at high risk for suicide ideation, attempts, and deaths. Among transgender individuals, 77% and 41% engage in suicide ideation and attempts in their lifetime, which exceeds general population rates (9.2% and 2.7% respectively). Traditionally, suicide risk factors have been studied using long period of time between measurements, making it difficult to understand short-term variability in suicide risk. Mobile phone applications offer opportunity to understand the immediate precursors of suicidality through the assessment of behaviors and moods in real-time. This is the first study to use a mobile phone app (TransLife) to understand short-term suicide risk factors among transgender individuals. OBJECTIVE This study’s objective is to beta test the usability of an evidence-informed mHealth suicide prevention phone app TransLife. The primary aims were to obtain preliminary data on user engagement and satisfaction with the app and to assess the feasibility of completing EMAs (mood logs) within the app. METHODS We used qualitative methods and an exploratory research approach that combined naturalistic app use, focus groups, and semi-structured phone interviews. Focus group informed the development of the prototype. We conducted a 3-week evaluation to determine engagement and obtain detailed user feedback about the app. Post pilot participation, phone-based, semi-structured, and audio-recorded exit interviews were conducted with research participants. RESULTS Sixteen transgender individuals participated in the study. On average, users logged in four times a week and spent approximately five minutes on the app per login. Six major themes emerged. These themes focused on the app’s functionality, satisfaction from using the app, perceived ease of use, perceived safety of providing personal data within the app, trusting the app enough to share personal feelings, and features that make this app engaging. These themes suggested that TransLife is an engaging, useful, and acceptable mHealth intervention. Participants reported that the app was easy to use and understand, supported mental self-care, promoted self-awareness, and helped them to identify triggers of negative moods. CONCLUSIONS The results of this pilot study indicate that TransLife is an engaging, acceptable, and potentially effective mental health intervention. Transgender participants reported many advantages from using TransLife, such as being able to track their mood, connect to the community, and access local resources. This study provides initial support for the acceptability and usability of TransLife as an mHealth intervention designed for the transgender community. CLINICALTRIAL This work was supported by the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS) NIMH grant P30MH058107. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.