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Given the increased use of smart devices and the advantages of individual behavioral monitoring and assessment over time, wearable sensor–based mobile health apps are expected to become an important part of future (forensic) mental health care. For successful implementation in clinical practice, consideration of barriers and facilitators is of utmost importance.
The aim of this study was to provide insight into the perspectives of both psychiatric outpatients and therapists in a forensic setting on the use and implementation of the Sense-IT biocueing app in aggression regulation therapy.
A combination of qualitative methods was used. First, we assessed the perspectives of forensic outpatients on the use of the Sense-IT biocueing app using semistructured interviews. Next, 2 focus groups with forensic therapists were conducted to gain a more in-depth understanding of their perspectives on facilitators of and barriers to implementation.
Forensic outpatients (n=21) and therapists (n=15) showed a primarily positive attitude toward the addition of the biocueing intervention to therapy, with increased interoceptive and emotional awareness as the most frequently mentioned advantage in both groups. In the semistructured interviews, patients mainly reported barriers related to technical or innovation problems (ie, connection and notification issues, perceived inaccuracy of the feedback, and limitations in the ability to personalize settings). In the focus groups with therapists, 92 facilitator and barrier codes were identified and categorized into technical or innovation level (n=13, 14%), individual therapist level (n=28, 30%), individual patient level (n=33, 36%), and environmental and organizational level (n=18, 20%). The predominant barriers were limitations in usability of the app, patients’ motivation, and both therapists’ and patients’ knowledge and skills. Integration into treatment, expertise within the therapists’ team, and provision of time and materials were identified as facilitators.
The chances of successful implementation and continued use of sensor-based mobile health interventions such as the Sense-IT biocueing app can be increased by considering the barriers and facilitators from patients’ and therapists’ perspectives. Technical or innovation-related barriers such as usability issues should be addressed first. At the therapist level, increasing integration into daily routines and enhancing affinity with the intervention are highly recommended for successful implementation. Future research is expected to be focused on further development and personalization of biocueing interventions considering what works for whom at what time in line with the trend toward personalizing treatment interventions in mental health care.
Over the last years, services that use information and communication strategies to improve and support health—eHealth—have grown tremendously owing to rapid technological changes [
Many eHealth interventions have been demonstrated to be feasible and acceptable [
In forensic psychiatry, personalized treatment interventions are highly relevant as a considerable number of forensic patients do not benefit from current treatment programs [
Considering the needs and preferences of intended users is one of the main prerequisites to bridge the gap between promising results of eHealth and mHealth studies on the one hand and actual deployment of these interventions in (forensic) mental health care on the other [
Given the scarcity of information on the deployment of sensor-based mHealth interventions in (forensic) mental health care, we aimed to provide more insight into the perspectives of both forensic outpatients (study 1) and therapists (study 2) regarding the use and implementation of a new sensor-based mHealth intervention, the Sense-IT biocueing app, in aggression regulation therapy (ART). More specifically, we focused on facilitators of and barriers to implementation, as identified by previous models. As we expected the feedback of forensic outpatients to be mainly centered on the technical or innovation level and the individual patient level, we included forensic therapists to provide us with information on all levels of the implementation model.
The perspectives of forensic outpatients on the use of the Sense-IT biocueing app were explored using qualitative semistructured interviews. In addition, usability was determined using a quantitative usability score. Data were collected at the postmeasurement assessment (T1) within a larger quasi-experimental study in which patients used the Sense-IT app for 4 weeks. More specific information on the design of this study can be found in another paper [
Forensic outpatients who received ART at Inforsa, a forensic mental health care organization in Amsterdam, the Netherlands, were recruited for participation between January 2020 and March 2022. First, patients were screened for eligibility by a research assistant, consulting the patients’ therapist. Patients were eligible for participation if they lacked anger management skills, were assigned to individual ART, had a basic understanding of mobile apps, and were aged ≥16 years. Patients were excluded if they had acute manic or psychotic symptoms, a high risk of suicide, severe physical conditions requiring immediate intervention, or insufficient understanding of the Dutch language. If a patient turned out to be eligible and interested in the research project, study participation was offered in a face-to-face appointment in which a brief oral description and full written information were provided.
After screening and informing the patients about the research project, 25 patients were eligible and willing to participate. All patients participated in a baseline measurement (T0) in which demographic characteristics, attitudes toward new technologies, and perceived proficiency in using new technologies were assessed. Next, they were provided with the Sense-IT app for 4 weeks, in which they received biocueing for 2 weeks. Using the photoplethysmography sensor of a smartwatch, this app compares the users’ current heart rate (HR) to their individual mean HR at rest, calculating a level between −3 and 5 using the SD of the baseline measurement. The app provides a visual display of the real-time HR level on the smartwatch and smartphone and notifies the users when their HR exceeds a predefined level using notifying vibrations and behavioral support messages. Screenshots of the Sense-IT app can be found in
This study was part of a larger study approved by the Medical Ethical Committee (NL63911.029.17) and registered in the Netherlands Trial Register (NL8206). Patients were carefully informed about the anonymous use of data, the voluntary nature of the study, and the absence of any negative consequences in case of refusal or early termination. All patients provided written informed consent before participation. Participating patients received a gift card of €10 (US $10.81) and an additional €10 (US $10.81) at T1 when at least 75% of the repeated experience sampling questions (not further reported here) were answered.
We organized the qualitative data of the outpatients using Microsoft Excel (Microsoft Corp). For categorical responses, cumulative frequencies were calculated using SPSS (version 27; IBM Corp). For open responses, content analysis was used. First, textual responses were inspected by the first author (JFtH) to gain familiarity with the data and establish a coding scheme. Next, the first and second authors (JFtH and LMS) independently coded the responses into predefined categories. Discrepancies were discussed between both authors until a consensus was reached. Discussion was also used to refine the categories and code descriptions to increase the interpretation of the codes. Quotes were jointly selected by both authors considering their informative value and ability to illustrate the category. Finally, selected quotes were translated from Dutch into English by JFtH and LMS.
The perspectives of forensic therapists on the implementation of the Sense-IT biocueing app were explored using focus groups. This study was designed to investigate the added value of the app from a therapist’s point of view, gain a better understanding of the perceived facilitators of and barriers to implementation, and collect suggestions for implementation.
Forensic therapists working within outpatient teams at Inforsa were recruited by email in February 2022. Therapists were eligible and invited to participate if they were trained in ART. No other inclusion or exclusion criteria were applied.
In total, 2 focus groups were conducted in February 2022 and March 2022. Both focus groups were scheduled within the existing structure of team meetings to avoid time burdens and added workload, thereby enhancing the chances of participation. In line with this structure (and also relevant from a content perspective), separate focus groups were organized for therapists working with young adults and therapists working with adults. Owing to COVID-19 regulations, some therapists participated on site, and others participated on the web. The planned group size was 6 to 8 participants to allow for optimal interaction between them [
At the start of the focus groups, a brief overview of the Sense-IT project was presented, including background information, screenshots of the app, and some qualitative results of earlier studies. After that, therapists completed a short form assessing demographic characteristics, attitude toward both mHealth in mental health care and new technologies, and perceived proficiency in using new technologies. In both focus groups, the same questioning route was used (
For this study among therapists, no ethical board review statement was applicable given the embedding in regular care routines and the low burden of participation. Therapists were informed that participation was voluntary, that information would be processed anonymously, and that the data would be used for research and policy purposes as well as for enhancement of the implementation process of the Sense-IT biocueing app. Before participation, therapists received an informative email and an informed consent form. All participants provided written informed consent. Participating therapists did not receive any financial reimbursements.
The focus groups were video- and audiotaped, transcribed in full by LMS, and analyzed by JFtH and LMS using content analysis. We used a combination of open and axial coding in a process of constant comparison [
In total, 21 forensic outpatients (n=19, 90% male and n=2, 10% female) filled out the SUS and participated in the interview at T1. Most participants (14/21, 67%) received mandatory treatment as a part of a conditional sentence. The main psychiatric disorders most frequently classified according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria were disruptive disorders (9/21, 43%) and personality disorders (8/21, 38%). Some participants were diagnosed with intellectual disability or scored below the cutoff on a screener for mild intellectual disability (8/21, 38%). At posttest measurement, forensic outpatients evaluated the usability of the Sense-IT biocueing app as acceptable (mean 73.13, SD 13.35). System usability was not significantly correlated with age, attitude toward new technology, or perceived proficiency in using new technologies. Notably, all patients returned the borrowed materials except for 10% (2/21), who reported that they had lost their smartwatch because of robbery. All descriptive characteristics are summarized in
Descriptive characteristics of forensic outpatients (study 1; N=21).
Variable | Values | |
Age (years), mean (SD) | 29.76 (10.60) | |
Male participants, n (%) | 19 (90) | |
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Western | 7 (33) |
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Non-Western | 7 (33) |
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Mixed | 7 (33) |
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None | 1 (5) |
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Primary education | 3 (14) |
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Junior secondary education | 12 (57) |
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Senior secondary education | 5 (24) |
Attitude toward new technologies, mean (SD)a | 4.33 (0.86) | |
Perceived proficiency in using new technologies, mean (SD)b | 8.00 (1.05) |
aMeasured on a 5-point Likert scale, with 1 indicating a (very) negative attitude and 5 indicating a (very) positive attitude.
bGraded on a 10-point scale, with 1 indicating no proficiency and 10 indicating excellent proficiency.
Forensic outpatients identified a wide range of advantages and disadvantages of the Sense-IT biocueing app. Responses mentioned more than once that could be grouped into categories are presented in
Clarity and simplicity of the app as well as support in interoceptive and emotional awareness were most frequently reported as advantages. Most patients (17/21, 81%) reported no difficulty in understanding how to use the app, and some (7/21, 33%) explicitly indicated that the app was clear and well organized. Furthermore, patients indicated that the app helped them become more aware of physical tension and that the questions in the app assisted them to reflect on their emotions and behavior during the day. A participant reported the following:
[The app helped me] to reflect on how things were going; I never really did that, but now I was aware whether I had a good day or a not so good day.
Connectivity issues, notification issues, and perceived inaccuracy were mentioned the most as disadvantages. Regarding connectivity issues, patients reported disturbance via interruptions in the Bluetooth connection, for example, when the distance between the smartphone and smartwatch was too large. As a potential solution, a patient suggested running the app stand-alone on the smartwatch itself so no Bluetooth connection would be needed. Furthermore, a substantial number of participants (8/21, 38%) reported that they received too many notifications or notifications that they perceived as either too soon or too late. In addition to the ability to adjust the (maximum) number of notifications, patients suggested sending notifications only when a higher HR was registered over a longer time. A participant recommended the following:
Add a button to put the app on pause, as a time-out, when you get irritated by the number of notifications, or when you already know [that you are tense].
Related to this, several patients (6/21, 29%) indicated that they would have preferred to customize the settings of the app themselves; their ability to do so was restricted in this study. For example, they would have liked to be able to adjust the number of notifications as well as the frequency and content of the daily questions according to their preferences. Furthermore, patients questioned the accuracy of the feedback provided by the app. Patients mentioned both elevations in HR when they did not subjectively experience stress and subjectively experiencing stress without detected elevations in HR. Patients reported that their activity profiles were not always recognized correctly by the app. Furthermore, patients reported missing specific design features such as the use of colors (eg, red color to signal high tension), graphical overviews, and more variety in watch faces (ranging from a very clear watch face with the actual HR to a watch face that is less easy to interpret for others). Other frequently mentioned disadvantages were the use of a study-provided smartphone and the limited battery life of the smartwatch.
Furthermore, we assessed in which specific situations the app was described as (not) pleasant or useful. Half (11/21, 52%) of the patients reported no specific situations or no situations at all in which they perceived the app as pleasant or useful. In retrospect, the app was perceived as most useful (mentioned by 7/21, 33% of the patients) in or shortly after discussions, confrontations, and other situations with a lot of tension to support awareness and emotion regulation. Related to this, the app was judged as not pleasant or useful in relaxed settings in which notifications perceived as inaccurate were reported as disturbing (5/21, 24% of the patients), during exercise or other physical activities (6/21, 29% of the patients), or when patients already felt too stressed or tired (3/21, 14% of the patients). A participant summarized this as follows:
In places where you have a lot of tension: it is good to put it [the smartwatch] on just then, and not in situations when you are calm.
Advantages and disadvantages of the Sense-IT biocueing app and the frequency with which each code was identified in the responses of the forensic outpatients (study 1; N=21).
Code | Code frequency, n (%) | Definition | |||
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Rationale | 4 (19) | The idea or rationale behind the app; its functionality | ||
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Simplicity | 7 (33) | The clarity and simplicity of the app and its functions | ||
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Awareness | 8 (38) | The helpfulness of the app to increase both interoceptive and emotional awareness | ||
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Behavioral support | 2 (10) | The helpfulness of the behavioral support messages | ||
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Perceived inaccuracy | 7 (33) | The perceived inaccuracy of the HRa measurements or the recognized activity profiles or the perceived limitations of the app to detect subjectively experienced stress | ||
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Notification issues | 8 (38) | Problems related to the amount (too many) or the timing (too soon or too late) of the notifications received | ||
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Connectivity issues | 8 (38) | Problems related to instability of the connection between smartwatch and smartphone | ||
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Use of a study-provided phone | 5 (24) | Problems related to the use of the app on a study-provided smartphone | ||
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Limited adaptive functionalities | 6 (29) | Limitations in the ability to personalize settings during the study | ||
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Design-related issues | 6 (29) | Problems related to personal design-related preferences | ||
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Other software issues | 4 (19) | Other problems related to the functions of the app | ||
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Limited battery life | 4 (19) | Limitations in the battery life of the smartwatch | ||
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Other hardware issues | 4 (19) | Other problems related to the smartwatch |
aHR: heart rate.
In total, 21 forensic therapists were invited to participate in the focus groups. A total of 24% (5/21) of the therapists preannounced that they were unable to participate for practical reasons. One new therapist, who did not receive the invitation, indicated willingness to participate and joined one of the focus groups. Eventually, another 10% (2/21) of the therapists did not participate. In total, 2 focus groups were conducted: one for therapists working with young adult patients (focus group 1; 6/15, 40%) and one for therapists working with adult patients (focus group 2; 9/15, 60%). In
Descriptive characteristics of the forensic therapists (study 2; N=15).
Variable | Focus group 1 (n=6) | Focus group 2 (n=9) | |
Age (years), mean (SD) | 35.00 (5.55) | 35.11 (7.99) | |
Female participants, n (%) | 5 (83) | 8 (89) | |
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Master psychologist or pedagogue | 4 (67) | 3 (33) |
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Health care psychologist (in training) | 0 (0) | 3 (33) |
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Clinical psychologist (in training) | 1 (17) | 3 (33) |
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Systemic therapist | 1 (17) | 0 (0) |
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<5 | 1 (17) | 3 (33) |
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5-10 | 2 (33) | 1 (11) |
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>10 | 3 (50) | 5 (56) |
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<5 | 4 (67) | 9 (100) |
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5-10 | 1 (17) | 0 (0) |
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>10 | 1 (17) | 0 (0) |
Attitude toward mHealtha in mental health care, mean (SD)b | 4.67 (0.52) | 3.89 (0.93) | |
Attitude toward new technologies, mean (SD)b | 4.50 (0.55) | 3.22 (1.30) | |
Perceived proficiency in using new technologies, mean (SD)c | 7.75 (1.41) | 6.72 (2.68) |
amHealth: mobile health.
bMeasured on a 5-point Likert scale, with 1 indicating a (very) negative attitude and 5 indicating a (very) positive attitude.
cGraded on a 10-point scale, with 1 indicating no proficiency and 10 indicating excellent proficiency.
In the first step of our analysis, we retrieved 39 codes from the 2 focus groups related to the added value of the Sense-IT biocueing app from the therapists’ perspective. These codes were categorized into themes and linked to the predefined levels in the questioning route. An overview of the results of this part of the coding process is shown in
At the therapist level, using the app to open up conversations was mentioned most frequently. A therapist noted the following:
I believe it’s great to be able to discuss with patients, who sometimes already forgot what they did yesterday...to zoom in on specific moments, to start talking about it.
At the patient level, increasing interoceptive and emotional awareness was mentioned the most. Therapists supposed that the app could help patients learn and experience how their body and mental state are connected and that reminders could help them be aware of the signals the body gives in everyday life. Furthermore, a therapist stressed the importance of these basal skills in the first stages of treatment:
I realize that body awareness precedes all those cognitive things.
At the level of treatment itself, therapists most frequently mentioned the impact on out-of-session practice, thereby increasing the transfer to everyday life. Therapists noted that wearing the smartwatch and using the app might also function as reminders for patients that they are in a process of learning to control their aggressive responses. They reported the following:
I suppose it can also help patients to be engaged in their treatment outside the therapy session. So it’s easier to generalize what you are doing [in therapy].
The therapy does not end in the room, but continues in daily life. The watch could also be a reminder for patients.
Patterns of meaningful responses (with code frequency) regarding the added value of the Sense-IT biocueing app according to forensic therapists (study 2).
In the second step of our analysis, 92 codes were retrieved on facilitators of and barriers to the implementation of the Sense-IT biocueing app in current treatment. The coded subthemes as well as the later defined themes were linked to the previously described levels [
Results of the coding process of facilitators of and barriers to implementation of the Sense-IT biocueing app in current treatment, as mentioned by forensic therapists (study 2)a.
Levels by Schreiweis et al [ |
Focus group 1 | Focus group 2 | ||||||||||
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Facilitators | Barriers | Facilitators | Barriers | ||||||||
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(Limited) ease of use | ✓b | ✓ |
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✓ | |||||
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Problems with materials |
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✓ |
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(Limited) simplicity | ✓ | ✓ | ✓ |
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Limited perceived accuracy |
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✓ | |||||
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Added workload |
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✓ |
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✓ | |||||
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Integration into treatment | ✓ |
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✓ |
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(Limited) technological skills | ✓ | ✓ |
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✓ | |||||
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Familiarity with the app | ✓ |
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✓ |
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Lack of problem insight |
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✓ |
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(Limited) openness to feedback | ✓ | ✓ |
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✓ | |||||
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(Limited) motivation | ✓ | ✓ | ✓ | ✓ | |||||
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Feeling controlled |
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✓ |
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✓ | |||||
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Specific psychiatric characteristics |
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✓ | ✓ | ✓ | |||||
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(Limited) technological skills | ✓ | ✓ | ✓ | ✓ | |||||
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Cognitive problems |
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✓ |
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✓ | |||||
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(Not) taking care of materials | ✓ | ✓ |
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✓ | |||||
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Practical issues |
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✓ |
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(Limited) expertise in team | ✓ | ✓ | ✓ | ✓ | |||||
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Providing sufficient time | ✓ |
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(Lack of) clear agreements | ✓ | ✓ | ✓ |
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(Problems in) providing materials | ✓ | ✓ | ✓ |
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Knowledge of effectiveness |
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✓ |
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(Limited) insight into costs and benefits | ✓ | ✓ |
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aTherapists working with young adults participated in focus group 1, and therapists working with adults participated in focus group 2.
b✓: indicates whether a theme was mentioned in the focus group and discussed as a facilitator and/or barrier.
The app should provide notifications at the right moments...so that patients continue to take the app seriously.
I can imagine that it helps if you can say, from your own perspective, that using the app can be a bit irritating at times. It might be useful to relate from your own experience.
Factors related to
You need to have the courage to start looking at yourself.
If all therapists just occasionally use the watch, then all will lack expertise.
If spending a lot of time on the app at the start is facilitated at the organizational level, then it can be done.
The therapists provided us with many other valuable suggestions regarding the use and implementation of the Sense-IT biocueing app, which will be used to inform the future process. In the context of this paper, 2 topics were highlighted. First, several therapists (4/15, 27%) recommended the use of the app in the first phases of treatment to increase awareness of physiological signals that precede aggressive behavior. Other therapists (2/15, 13%) suggested the use of the app in later phases of treatment; one therapist reported focusing on motivation first, whereas another suggested using the app during therapy sessions to evaluate different emotion regulation strategies. Second, therapists working with young adults explored opportunities for a more systemic approach. Therapists mentioned that the use of the app could probably increase awareness among system members as well and might help enable system members to adequately support the patient in moments when physiological tension is elevated.
The aim of this study was to provide insight into the perspectives of both forensic psychiatric outpatients and therapists on the use and implementation of a new sensor-based mHealth intervention for ART. More specifically, we aimed to obtain a more in-depth understanding of the facilitators of and barriers to implementation, which could be used as guideposts for future research and clinical practice. Findings from both studies indicate an overall positive attitude toward the addition of a biocueing intervention in forensic therapy, with increased interoceptive and emotional awareness as the most frequently and commonly mentioned advantage. The main barriers at the
At the
The findings regarding the perceived advantages of this sensor-based biocueing app resonate with the results of previous mHealth studies. Increased awareness (mentioned by both patients and therapists) and the ability to open up conversations by zooming in on specific situations (mentioned by therapists) align with previously described benefits of mHealth [
Barriers and facilitators identified in the focus groups were linked to the 3 factors associated with eHealth implementation [
The disadvantages mentioned by the patients corresponded, to a large extent, to the barriers at the
The barriers identified at the
At the
Finally, at the
This study has several strengths. First, we were able to assess the experiences and perspectives of forensic outpatients, who are often hard to engage in clinical research. Most participants seemed to enjoy delivering feedback on how to improve this new sensor-based mHealth intervention. Second, we combined the information of forensic outpatients with the input of forensic therapists to obtain a more complete overview of the barriers and facilitators associated with implementation. To do so, we combined a more general implementation model with a more specific eHealth implementation model. Finally, this study was well embedded in daily clinical practice, thereby enhancing the ecological validity and translation of these research results into real-world situations.
Our study also had several limitations. In both studies, attitudes toward new technologies (and mHealth) as well as perceived proficiency in using those technologies were assessed using self-developed Likert-scale questions. The use of recently developed and validated scales such as the eMental Health Adoption Readiness scale [
In addition to suggestions for further improvement of this particular biocueing app and other issues requiring attention (ie, perceived accuracy of the app, accessibility for patients with intellectual disabilities, and ethical concerns regarding surveillance and persuasion), this study provided valuable information to guide the implementation of sensor-based mHealth interventions in (forensic) mental health care. As the implementation of eHealth and mHealth largely depends on the providers of these interventions [
Therapists and patients provided several suggestions for using a biocueing app in clinical practice. Although these suggestions specifically apply to the studied intervention, they might also be informative for other researchers developing and implementing similar sensor-based mHealth interventions in (forensic) mental health care. According to the therapists, the addition of a biocueing intervention would be most useful in the first phases of treatment to increase interoceptive awareness. When patients display a certain amount of motivation to change and receptivity to feedback, they might also benefit from the just-in-time behavioral support delivered by the biocueing app. As this involves a reminder to use coping skills to reduce stress, it is necessary that the therapist has already discussed emotion regulation strategies with the patient and that the behavioral support message is prepared in collaboration. Patients indicated that the app was most helpful in difficult situations, and it was perceived as disturbing in relaxed situations, during exercise, or when they already felt too stressed or tired. This emphasizes the need to further adapt these new interventions to deliver mental health support at precisely those moments, when they are most likely to be effective [
Forensic outpatients and therapists demonstrated a positive attitude toward the addition of a wearable sensor–based mHealth intervention, the Sense-IT biocueing app, to ART. Increased interoceptive and emotional awareness were mentioned as advantages by both patients and therapists. However, to maximize the potential of these interventions, several important barriers and facilitators should be addressed. Forensic outpatients mainly reported technical or innovation-related barriers, whereas therapists provided us with a more in-depth understanding of barriers and facilitators at the individual and organizational levels. A substantial part of the technical or innovation-related barriers is related to the developmental stage of the app and its use in a research context, and therefore, quite easy to address. Furthermore, although some individual patient barriers apply specifically to forensic patients, most factors should also be carefully considered in other populations with emotion regulation difficulties. At the individual therapist and organizational level, providing time and materials supporting integration into daily routines and enhancing affinity with the new intervention were identified as important facilitators of implementation and, therefore, are highly recommended. In the future implementation process, individual and team differences in readiness for adoption of mHealth should be considered, assigning a central role to active users as experts within the teams. Finally, as further development of biocueing interventions is expected, new and personalized app possibilities might be discovered and investigated at the individual patient level, aligning with the trend of personalizing treatment interventions in mental health care.
Screenshots of the Sense-IT biocueing app (version 2.57): the main screen, measurement screen, notes screen, and one of the watch faces.
Questioning route.
aggression regulation therapy
heart rate
mobile health
System Usability Scale
This study was conducted within a larger research project financially supported by the Dutch Ministry of Justice and Security. The authors would like to thank the participating patients and therapists of Inforsa, forensic mental health care organization in Amsterdam, the Netherlands, for their valuable feedback. Furthermore, they would like to thank the organizations involved in the development of Sense-IT for use in this study project: University of Twente, Scelta/GGNet, Amsterdam University Medical Center, Inforsa/Arkin, and Pluryn.
The data sets generated and analyzed during this study are available from the corresponding author upon reasonable request.
JFtH, LTAS, MLN, AP, and TMvdP conceived the entire study and developed the study designs. JFtH coordinated the data collection and data processing of study 1. JFtH and LMS conducted the focus groups and analyzed the data of study 2. TMvdP verified the completed analysis. JFtH drafted the manuscript in close cooperation with LMS. LTAS, MLN, AP, AEG, and TMvdP critically revised and approved the final version of this manuscript.
JFtH and MLN (and, more remotely, TMVdP and AP) were involved in the development process of the Sense-IT biocueing app. They have no commercial or financial relationships that could be construed as potential conflicts of interest. LMS, LTAS, and AEG also have declared that they have no competing or potential conflicts of interest.