Background: Patients can struggle to make good use of psychotherapy owing to deficits in awareness, and digital technologies that support awareness are at a premium. Currently, when patients participate in cognitive analytic therapy (CAT), the technology supporting relational awareness work involves completion of paper-based worksheets as between-session tasks. Objective: We aimed to design, with therapists and patients, a prototype digital mobile app. This was to help patients better engage in the “recognition” phase of the CAT treatment model by providing an unobtrusive means for practicing relational awareness with dynamic feedback on progress. Methods: A national online survey was conducted with CAT therapists (n=50) to determine readiness for adoption of a mobile app in clinical practice and to identify core content, functionality, and potential barriers to adoption. A prototype mobile app based on data and existing paper-based worksheets was built. Initial face-to-face user testing of the prototype system was completed with three therapists and three CAT expatients. Results: Among the therapists surveyed, 72% (36/50) reported not currently using any digital tools during CAT. However, the potential value of a mobile app to support patient awareness was widely endorsed. Areas of therapist concern were data security, data governance, and equality of access. These concerns were mirrored during subsequent user testing by CAT therapists. Expatients generated additional user specifications on the design, functionality, and usability of the app. Results from both streams were integrated to produce five key changes for the reiteration of the app. Conclusions: The user-centered design process has enabled a prototype CAT-App to be developed to enhance the relational awareness work of CAT. This means that patients can now practice relational awareness in a much more unobtrusive manner and with ongoing dynamic feedback of progress. Testing the acceptability and feasibility of this technological innovation in clinical practice is the next stage in the research process, which has since been conducted and has been submitted. The important challenges of data protection and governance must be navigated in order to ensure implementation and adoption if the CAT-App is found to be acceptable and clinically effective.

中文翻译：

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将认知分析疗法与数字支持工具相融合：涉及以用户为中心的原型应用设计的混合方法研究

背景：由于意识不足，患者可能难以充分利用心理治疗，而支持意识的数字技术极为重要。当前，当患者参加认知分析治疗（CAT）时，支持关系意识工作的技术涉及完成基于纸的工作表，作为会话间的任务。目标：我们旨在与治疗师和患者一起设计原型数字移动应用程序。通过提供一种轻松的方式来实践关系意识并动态反馈进展情况，从而帮助患者更好地参与CAT治疗模型的“识别”阶段。方法：与CAT治疗师（n = 50）进行了一项全国性在线调查，以确定是否愿意在临床实践中采用移动应用程序，并确定核心内容，功能和采用的潜在障碍。构建了一个基于数据和现有纸质工作表的移动应用程序原型。原型系统的最初面对面用户测试由三名治疗师和三名CAT病人完成。结果：在接受调查的治疗师中，有72％（36/50）报告称在CAT期间当前未使用任何数字工具。但是，广泛认可了移动应用程序对支持患者意识的潜在价值。治疗师关注的领域是数据安全性，数据治理和访问平等。CAT治疗师在随后的用户测试中反映了这些担忧。急诊人员针对应用程序的设计，功能和可用性生成了其他用户规范。来自两个流的结果被集成以产生五个关键更改，以重申该应用程序。结论：以用户为中心的设计过程使CAT-App原型得以开发，以增强CAT的关系意识工作。这意味着患者现在可以以更加不显眼的方式并不断获得动态的进展反馈来练习关系意识。测试该技术创新在临床实践中的可接受性和可行性是研究过程的下一阶段，此阶段已开展并已提交。如果发现CAT-App是可接受的并且在临床上有效，则必须应对数据保护和治理的重要挑战，以确保实施和采用。