Self-help Application for Obsessive-Compulsive Disorder Based on Exposure and Response Prevention Technique: Prototype Design and Usability Evaluation (Preprint)

Abstract

Obsessive-compulsive disorder (OCD) is a relatively common disorder that, due to its debilitating nature, significantly affects personal abilities, job performance, social adjustment, and interpersonal relationships. There are significant barriers to accessing evidence-based cognitive-behavioral therapy as a first-line treatment for obsessive-compulsive disorder. Mobile health applications (Apps) offer a promising way to improve access to evidence-based therapies while overcoming these barriers.

This study aimed to design and evaluate a prototype of a self¬-help application for people with contamination OCD based on exposure and response prevention (ERP) technique.

This work was developed in four different phases. 1) Needs assessment: Thorough literature review, reviewing existing related programs and apps, and interviewing patients and psychiatrists; 2) Create paper prototype: Considering the functional features identified in the previous phase using wireframe sketcher software. 3)Create digital prototype: developing an actual prototype using Axure RP software based on the information obtained from the evaluation of the paper prototype by expert panel. 4) Prototype usability evaluation: Through a heuristic evaluation with experts and a usability testing with patients using SUS questionnaire.

After requirement analysis, requirements were defined in the areas of information and educational elements and functional capabilities. Prototypes designed based on identified requirements include capabilities such as in-app online self-help group, assessing the severity of the symptoms of the disorder, psychological training, supportive treatment strategies, setting personalized treatment plan, tracking treatment progress through weekly reports provided, anxiety assessment, setting reminder. The results of heuristic evaluation of 5 experts showed that out of the total identified problems, the most problems are related to the” aesthetic and minimalist design” principle and the least problems are related to ”visibility of system status” and” flexibility and efficiency of use”. No problems were identified for “good error message”. Violated problem in the final application should be resolved and refinement can be made based on the experts' comments and suggestions. In usability testing with 10 patients, mean score of patients’ responses in the SUS questionnaire was 76.75 that indicates that the usability of the app prototype is good from the patient's perspective.

The results of heuristic evaluation with experts made it possible to identify how to provide information and to implement the capabilities in a way that can be more appropriate and easier for the user Furthermore, the results of the usability evaluation with potential prototype users showed the that implementing remote treatment with mobile app can be promising to help people with contamination OCD.