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Digital technologies for health and wellbeing are growing in use and sophistication, presenting both opportunities and challenges in their design. The increasing use of mobile apps in this context offers the potential to improve public health and a rich source of material for design research. However, their relatively recent arrival and short time frame of adoption means we are still at the early stages of understanding of how and why they work best (Walsh et al., 2016). In order to build a sustainable body of knowledge we need to understand how these apps differ from other digital technologies in terms of context and strategy of communication and examine the ethical implications for design.
Mental health is a major determinant of wellbeing and a concern for society (WHO, 2012). Mobile devices can help identify people who are struggling with depression, by delivering validated psychological health screening surveys, with the benefit of ‘anytime, anywhere’ usage. In addition, smartphones and tablets can support the implementation of data collection techniques, such as the on-going and remote monitoring of mood and other symptoms (Matthews & Doherty, 2011). A number of commercial smart phone applications have been developed in recent years to support psychological wellbeing among the general population, such as offering mindfulness techniques (Headspace), improving sleep and rest skills (DeepSleep), using CBT therapy (MoodGym) or specific tools to assess anxiety, PTSD and depression (CPT Coach, What’s My M3). Some apps focus on physical and mental health during particular life events such as bereavement (Grief: Support for Young People), illness (CaringBridge) or pregnancy (Baby Bump, Mind The Bump). Others offer tools, planning and reporting facilities towards healthier lifestyles (e.g. Balanced, Life Charge). Menstruation tracking apps such as ‘Clue’ offer a combination of mood tracking, symptom analysis, fertility awareness and feedback for monitoring physical and psychological aspects of the cycle.
Mobile technologies for psychological wellbeing have also been developed for use in controlled clinical releases, involving individual users whose specifications go beyond standard (UX) research and design requirements for the general user. For example, apps focusing in particular on young people and teenagers have been designed to allow them to record and monitor symptoms of depression and anxiety which therapists can review (Matthews & Doherty, 2011), or for tracking mood and feelings to enhance personal autonomy for young people with chronic health problems in transition from paediatric to adult medicine (van der Velden & Machniak, 2016). Further studies have utilised automatic smartphone sensing to generate passive data for monitoring mood rhythms of individuals with bipolar disorder (Abdullah et al., 2016).
Such mHealth applications operate in a design space that needs to accommodate complex issues involving intimate interactivity with personal information, where offline communications frequently reflect poor communication, strategic or deliberate lack of engagement and mixed outcomes. Therefore, the design process needs to include collaboration with mental health professionals as well as deeper research on potential end-users at a very early stage with a particular focus on encouraging engagement (Doherty et al., 2010b). Where active input and interactivity is required, design also needs to support client-therapist relationships without placing excessive burdens or expectations on either (Doherty, Coyle & Matthews, 2010).