Developing a mHealth Routine Outcome Monitoring and Feedback App (“SMART Track”) to Support Self-Management of Addictive Behaviours

Background: Routine outcome monitoring (ROM) has been implemented across a range of addiction treatment services, settings and organisations. Mutual support groups are a notable exception. Innovative solutions are needed. SMART Track is a purpose built smartphone app designed to capture ROM data and provide tailored feedback to adults attending Australian SMART Recovery groups for addictive behaviour(s).Objective: Details regarding the formative stage of app development is essential, but often neglected. Improved consideration of the end-user is vital for curtailing app attrition and enhancing engagement. This paper provides a pragmatic example of how principles embedded in published frameworks can be operationalised to address these priorities during the design and development of the SMART Track app.Methods: Three published frameworks for creating digital health technologies (“Person-Based Approach,” “BIT” Model and IDEAS framework) were integrated and applied across two stages of research to inform the development, design and content of SMART Track. These frameworks were chosen to ensure that SMART Track was informed by the needs and preferences of the end-user (“Person-Based”); best practise recommendations for mHealth development (“BIT” Model) and a collaborative, iterative development process between the multi-disciplinary research team, app developers and end-users (IDEAS framework).Results: Stage one of the research process generated in-depth knowledge to inform app development, including a comprehensive set of aims (clinical, research/organisation, and usage); clear articulation of the target behaviour (self-monitoring of recovery related behaviours and experiences); relevant theory (self-determination and social control); appropriate behavioural strategies (e.g., behaviour change taxonomy and process motivators) and key factors that may influence engagement (e.g., transparency, relevance and trust). These findings were synthesised into guiding principles that were applied during stage two in an iterative approach to app design, content and development.Conclusions: This paper contributes new knowledge on important person-centred and theoretical considerations that underpin a novel ROM and feedback app for people with addictive behaviour(s). Although person-centred design and best-practise recommendations were employed, further research is needed to determine whether this leads to improved usage outcomes.Clinical Trial Registration: Pilot Trial: http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336.

Evaluation of an Online System for Routine Outcome Monitoring: A Cross-Sectional Survey (Preprint)

BACKGROUND The use of Routine Outcome Monitoring (ROM) in the treatment of mental health has emerged as a method of improving psychotherapy treatment outcomes. Despite this, very few clinicians regularly use ROM in clinical practice. Online ROM has been suggested as a solution to increase adoption. OBJECTIVE To identify the influence of moving ROM online on client completion rates of self-reported outcome measures and to identify implementation and utilization barriers to online ROM by assessing clinicians’ views on their experience utilizing the online system over previous paper-based methods. METHODS Client completion rates of self-reported outcome measures were compared pre and post implementation of an online system of ROM. In addition, a survey questionnaire was administered to 340 mental health service providers regarding their perception of benefits with an online system of ROM. RESULTS Client completion rates of self-reported measures increased from 15% to 54% after moving online. Fifty-eight% of service providers found the new system less time consuming than previous paper-based ROM and 64% found that it helped monitor clients. However, the perceived value of the system remains in doubt as only 23% found it helped them identify clients at risk for treatment failure, and only 18% found it strengthened the therapeutic alliance. CONCLUSIONS Although the current study suggests mixed results regarding service providers’ views on their experience using an online system for ROM, it has identified barriers and challenges that are actionable for improvement.