Background: Bipolar disorder is a serious mental illness that results in significant morbidity and mortality. Pharmacotherapy is the primary treatment for bipolar disorder; however, adjunctive psychotherapy can help individuals use self-management strategies to improve outcomes. Yet access to this therapy is limited. Smartphones and other technologies have the potential to increase access to therapeutic strategies that enhance self-management while simultaneously providing real-time user feedback and provider alerts to augment care. Objective: This paper describes the user-centered development of LiveWell, a smartphone-based self-management intervention for bipolar disorder, to contribute to and support the ongoing improvement and dissemination of technology-based mental health interventions. Methods: Individuals with bipolar disorder first participated in a field trial of a simple smartphone app for self-monitoring of behavioral targets. To develop a complete technology-based intervention for bipolar disorder, this field trial was followed by design sessions, usability testing, and a pilot study of a smartphone-based self-management intervention for bipolar disorder. Throughout all phases of development, intervention revisions were made based on user feedback. Results: The core of the LiveWell intervention consists of a daily self-monitoring tool, the Daily Check-in. This self-monitoring tool underwent multiple revisions during the user-centered development process. Daily Check-in mood and thought rating scales were collapsed into a single wellness rating scale to accommodate user development of personalized scale anchors. These anchors are meant to assist users in identifying early warning signs and symptoms of impending episodes to take action based on personalized plans. When users identified personal anchors for the wellness scale, the anchors most commonly reflected behavioral signs and symptoms (40%), followed by cognitive (25%), mood (15%), physical (10%), and motivational (7%) signs and symptoms. Changes to the Daily Check-in were also made to help users distinguish between getting adequate sleep and keeping a regular routine. At the end of the pilot study, users reported that the Daily Check-in made them more aware of early warning signs and symptoms and how much they were sleeping. Users also reported that they liked personalizing their anchors and plans and felt this process was useful. Users experienced some difficulties with developing, tracking, and achieving target goals. Users also did not consistently follow up with app recommendations to contact providers when Daily Check-in data suggested they needed additional assistance. As a result, the human support roles for the technology were expanded beyond app use support to include support for self-management and clinical care communication. The development of these human support roles was aided by feedback on the technology's usability from the users and the coaches who provided the human support. Conclusions: User input guided the development of intervention content, technology, and coaching support for LiveWell. Users valued the provision of monitoring tools and the ability to personalize plans for staying well, supporting the role of monitoring and personalization as important features of digital mental health technologies. Users also valued human support of the technology in the form of a coach, and user difficulties with aspects of self-management and care-provider communication led to an expansion of the coach's support roles. Obtaining feedback from both users and coaches played an important role in the development of both the LiveWell technology and human support. Attention to all stakeholders involved in the use of mental health technologies is essential for optimizing intervention development.

中文翻译：

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基于智能手机的双相情感障碍自我管理干预 (LiveWell)：以用户为中心的开发方法

背景：双相情感障碍是一种严重的精神疾病，会导致显着的发病率和死亡率。药物治疗是双相情感障碍的主要治疗方法；然而，辅助心理治疗可以帮助个人使用自我管理策略来改善结果。然而，获得这种疗法的机会是有限的。智能手机和其他技术有可能增加获得治疗策略的机会，从而增强自我管理，同时提供实时用户反馈和提供者警报以增强护理。目的：本文描述了 LiveWell 以用户为中心的开发，这是一种基于智能手机的双相情感障碍自我管理干预措施，以促进和支持基于技术的心理健康干预措施的持续改进和传播。方法：双相情感障碍患者首先参加了一项用于自我监控行为目标的简单智能手机应用程序的现场试验。为了开发针对双相情感障碍的完整的基于技术的干预，该现场试验之后是设计会议、可用性测试和基于智能手机的双相情感障碍自我管理干预的试点研究。在开发的所有阶段，干预修订都是根据用户反馈进行的。结果：LiveWell 干预的核心包括每日自我监控工具，即每日签到。这种自我监控工具在以用户为中心的开发过程中经历了多次修改。每日签到心情和思想评级量表被折叠成一个单一的健康评级量表，以适应个性化量表锚的用户开发。这些锚点旨在帮助用户识别即将发生的事件的早期预警信号和症状，以便根据个性化计划采取行动。当用户确定健康量表的个人锚点时，这些锚点最常反映行为体征和症状 (40%)，其次是认知 (25%)、情绪 (15%)、身体 (10%) 和动机 (7%)体征和症状。还对每日签到进行了更改，以帮助用户区分获得充足的睡眠和保持规律的作息。在试点研究结束时，用户报告说，每日签到让他们更加了解早期预警信号和症状以及他们的睡眠时间。用户还报告说他们喜欢个性化他们的主播和计划，并认为这个过程很有用。用户在开发、跟踪和实现目标时遇到了一些困难。当每日签到数据表明他们需要额外的帮助时，用户也没有始终如一地跟进应用建议以联系供应商。因此，该技术的人工支持角色已从应用程序使用支持扩展到包括对自我管理和临床护理沟通的支持。结论：用户输入指导了 LiveWell 干预内容、技术和辅导支持的开发。用户重视监测工具的提供和个性化保持健康计划的能力，支持监测和个性化作为数字心理健康技术的重要特征的作用。用户还重视以教练的形式对技术的人工支持，而用户在自我管理和护理提供者沟通方面的困难导致教练的支持角色扩大。从用户和教练那里获得反馈在 LiveWell 技术和人力支持的发展中发挥了重要作用。关注所有参与使用精神卫生技术的利益相关者对于优化干预措施的发展至关重要。