Wearable augmented digital therapy for people with psychosis (SloMo): Mixed methods co-design study (Preprint)

BACKGROUND Digital health interventions for psychosis, like SloMo, leverage smartphone technology to help transfer learning from therapy to real-life situations. Usage relies on motivation, recall, and awareness. Wearable devices that track physiological signs of stress can boost engagement by encouraging the use of coping strategies when most needed. OBJECTIVE To co-design an integrated user interface for wearable technology and the SloMo mobile app, and to validate its usefulness, usability, and acceptability to individuals with psychosis. METHODS A co-design team, including 10 experts by experience, developed the wearable augmented SloMo app using the Double Diamond framework. Users tested the app for 8 consecutive weeks, providing feedback that guided iterative improvements. User experience ratings and assessments of the technology's potential to reduce paranoia and improve wellbeing were collected pre- and post-use. RESULTS The Spire Stone clothing-adhered biosensor, which monitors respiratory rate and stress physiology, was chosen to augment SloMo. A minimum viable product of an integrated interface was developed. Feedback identified that users needed the technology to be easy to use, secure and tailored to them through user control. Eighty percent of users reported that the wearable prompted increased use of the SloMo app’s features and other coping strategies. Engagement levels and experience varied: those who used the technology most reported improvements to paranoia and high satisfaction. Conversely, individuals that engaged with the device less experienced slight increases in paranoia and were only modestly satisfied. CONCLUSIONS Wearable technology is generally acceptable and can augment a digitally-supported therapy for psychosis and promote engagement. However, further development work is needed for the technology to be acceptable and useful to a broader range of people. CLINICALTRIAL SloMo Trial Registration: ISRCTN 32448671