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People with mental health disorders live, on average, 20 years less than those without, often because of poor physical health including cardiovascular disease (CVD). Evidence-based interventions are required to reduce this lifespan gap.
This study aimed to develop, test, and evaluate a mobile phone–based lifestyle program (MyHealthPA) to help people with mental health problems improve key health risk behaviors and reduce their risk of CVD.
The development of MyHealthPA occurred in 3 stages: (1) scoping of the literature, (2) a survey (n=251) among people with and without the experience of mental health problems, and (3) program development informed by stages 1 and 2. A small pilot trial among young people with and without mental health disorders was also conducted. Participants completed a baseline assessment and were given access to the MyHealthPA program for a period of 8 weeks. They were then asked to complete an end-of-treatment assessment and a follow-up assessment 1 month later.
In the study, 28 young people aged 19 to 25 years were recruited to the pilot trial. Of these, 12 (12/28, 43%) had been previously diagnosed with a mental illness. Overall, 12 participants (12/28, 43%) completed the end-of-treatment assessment and 6 (6/28, 21%) completed the follow-up assessment. Small improvements in fruit and vegetable consumption, level of physical activity, alcohol use, and mood were found between baseline and end of treatment and follow-up, particularly among people with experience of mental health issues. Most participants (history of mental illness: 4/7, 57%; no history of mental illness: 3/5, 60%) reported the program had above average usability; however, only 29% (2/7, no history of mental illness) to 40% (2/5, history of mental illness) of participants reported that they would like to use the program frequently and would recommend it to other young people. Participants also identified a number of ways in which the program could be improved.
This study describes the formative research and process of planning that formed the development of MyHealthPA and the evidence base underpinning the approach. The MyHealthPA program represents an innovative approach to CVD risk reduction among people with mental health problems. MyHealthPA appears to be an acceptable, easy-to-use, and potentially effective mHealth intervention to assist young people with mental illness to monitor risk factors for CVD. However, ways in which the program could be improved for future testing and dissemination were identified and discussed.
People with mental health disorders live on average 20 years less than the general population [
Recent research has shown that changing multiple behavioral risk factors and reducing CVD risk is possible among people with mental health problems [
Mobile phone–based interventions to reduce CVD risk may be able to address these needs. Through mobile devices, individualized interventions can be provided inexpensively to a large number of people, including those who are geographically isolated, at a time and place when they are ready to engage in treatment [
The development of MyHealthPA occurred in 3 stages: (1) scoping of the literature, (2) survey among people with and without experience of mental health problems, and (3) program development. These stages are detailed below.
This stage aimed to identify, from previous research, the key strategies required to improve behavioral risk factors associated with CVD and develop a mobile phone–based tool for people with mental health problems. The main features considered in our examination of the existing literature included the intervention content and the delivery and design of the intervention.
Ward et al [
Baker et al conducted the only trial to-date of interventions for people with mental health disorders targeting smoking and alcohol use as well as diet and exercise [
Key CBT techniques such as self-monitoring and goal setting have been identified as central to successful CVD risk–reduction interventions among people with and without mental health problems. Meta-analyses provide evidence for the efficacy of self-monitoring of diet, physical activity, weight, and tobacco and alcohol use [
The available literature suggests that even the most popular existing mobile health apps (eg, MyFitnessPal) have poor usability, even among the general population [
Rotondi et al [
Ferron et al [
To ensure the MyHealthPA program was tailored to the needs of people with mental health problems, scoping research with potential end users of the program was conducted.
Participants were recruited via paid and unpaid advertisements on social media to participate in a brief survey of attitudes toward using mobile phone–based technology for health-related behaviors. Those who clicked on the study advertisements were directed to a Web-based information statement and consent form and then directed to the self-report questionnaire hosted by the Web-based survey program Fluid Surveys if they chose to participate. The survey was also sent to 200 members of a community research register who were asked to return the consent form and self-report questionnaire in a reply-paid envelope. Participants were required to be aged over 18 years and currently living in Australia.
The survey included items regarding demographic characteristics, mobile phone access and use, and openness to using mobile phone technologies for health purposes. Participants were also asked to indicate if they had ever been diagnosed with a mental illness. Current psychological distress was assessed using the Patient Health Questionnaire, PHQ 4 [
Of the 722 people who accessed the Web-based survey, 334 (334/722, 46.2%) provided consent and were eligible to participate in the study and 249 (249/722, 34.4%) provided sufficient data to be included in the analysis of this study. Of the 200 members of the community research register contacted, 35 (35/200, 17.5%) returned completed questionnaires. The final sample of 284 participants was aged between 18 and 77 years (mean 30.64, SD 14.49). The majority of participants were females (152/284, 53.5%), held a university degree (141/284, 49.6%), were employed (156/284, 54.9%), and lived in a major city (223/284, 78.5%). Approximately half of participants reported a history of mental illness (137/284, 48.2%), including 109 with a history of depression, 108 with a history of anxiety, 5 who had been previously diagnosed with a psychotic disorder, 11 with an eating disorder, 5 with a bipolar disorder, 8 with a borderline personality disorder, and 6 with a posttraumatic stress disorder. However, most (181/251, 72.1%) reported no (or mild) current psychological distress.
Of the 251 participants who provided information about their mental health status, 144 (144/251, 57.4%) reported experiencing mental health problems, including 61 (61/251, 24.3%) who reported a history of mental illness and current psychological distress, 73 (73/251, 29.1%) reporting a history of mental illness but no current psychological distress, and 10 (10/251, 4.0%) reporting current psychological distress but no history of mental illness. Overall, 107 participants (107/251, 42.6%) reported neither a history of mental illness nor current psychological distress.
Participants reported extremely high levels of access to mobile phone technology, with 93.5% to 100% of participants reporting they owned or had easy access to a mobile phone. The majority of participants had previously used their mobile phone to access information or treatment for physical health concerns (184/251, 73.3%). Most participants with a history of mental illness or current psychological distress had also done so specifically for mental health concerns (114/144, 79.2%). Fewer had accessed information or treatment for drug and alcohol concerns (52/144, 36.1%). Across these different types of health concerns, most participants reported that they would consider accessing treatment via a mobile phone (62.3%-75.8%).
When asked if they were interested in receiving information or treatment via a mobile phone about a range of health concerns, few participants (12.5%-29.1%) were interested in specifically addressing CVD (see
Although very few participants, overall, were interested in addressing smoking (20/190, 10.5%) or alcohol use (24/190, 12.6%) via a mobile phone, interest in addressing these issues was higher among frequent users of these substances. Among participants reporting daily (or almost daily) use of alcohol, 60% (6/10) of participants with a mental health problem (Those with current distress, a history of mental illness or both) reported that they would be interested in addressing alcohol use via a mobile phone. Only 17% (2/12) of daily drinkers without a mental health problem were interested in addressing alcohol use via a mobile phone. Similarly, among daily smokers, 81% (13/16) of participants with mental health problems were interested in addressing smoking, and 75% (3/4) of smokers without a mental health problem were interested in addressing smoking.
The initial content of MyHealthPA was informed by the scoping of the literature and survey research described above. This study suggested it is appropriate to address risk of CVD for people with mental health problems using a mobile phone–based intervention. It also highlighted that the MyHealthPA program needed to, at a minimum, include self-monitoring and goal-setting techniques, provide feedback on behaviors of the users, adopt a multiple health behavior change framework, and should address individual risk factors as opposed to CVD specifically. The initial content was written so that it was brief, there was minimal introductory content, it explicitly communicated concepts, and it was easy to read, in line with the principles of the FEDM [
Furthermore, 2 academics and 2 clinicians with expertise in health behavior change among people with mental health problems reviewed the initial written content. Feedback on the initial content was that it was accurate and correct in accordance with the most current research and behavior change techniques. Any information that was queried was checked with the literature and changed accordingly. Minor changes to the language to improve the readability of content were also made.
A beta version of the MyHealthPA program was then developed. Initial usability testing was first undertaken, and any technical issues identified were resolved before the app was reviewed by 2 academics, 2 clinicians, and 2 mental health consumers. These reviewers provided feedback regarding the final content, usability, and appeal of the program. The beta version of MyHealthPA was informed by the FEDM [
The key change made to the program based on feedback from reviewers was that the emoticon mood-rating system was changed to a 10-point Likert scale where users answer the question “How do you feel today?” Descriptors of 1 = the worst I have ever felt of could ever imagine feeling; 5 = in the middle, neither very bad or very good; and 10 = the best I have ever felt or could ever imagine feeling were used to help guide users’ responses. If users select
MyHealthPA provides users with feedback regarding smoking, alcohol use, fruit and vegetable consumption, and physical activity; allows users to easily record their health behaviors and mood on any mobile device; and track their progress over time. Users can also set health behavior goals, and reminders are sent to record behaviors (see
When users first access MyHealthPA, they are asked to complete a brief questionnaire regarding their health behavior and mood, at the end of which they are provided with personalized feedback regarding their health behaviors based on national guidelines [
Home page: This page provides a simple and visual portrayal of the diary entry of the current day, a motivational quote from the Personal Assistant avatar, and a menu to access all other pages.
My Diary: This page allows users to record their mood and health behaviors (number of cigarettes, number of alcoholic drinks, minutes of physical activity, and/or serves of fruits and vegetables consumed) for the day. Participants can also record if they have taken any medications as prescribed that day and any withdrawal (scale name) or adverse psychiatric symptoms (scale name) they may have experienced.
My Progress: This page allows users to view their progress via an interactive graph that users can use to display changes in multiple health behaviors and/or mood over time.
My Goals: This page allows users to set goals, including due dates for these goals, related to each of the measured health behaviors (eg, set a quit date and quit smoking, reduce the number of alcoholic drinks in a day to XX, eat 2 servings of fruit per day, and exercise XX times per week) and displays any current goals they have set. A pop-up textbox also provides users with tips on setting Specific, Measurable, Active, Realistic, and Time-limited (SMART) goals.
My Profile: On this page, users can enter and edit their personal information (eg, name, gender, height, weight, contact details, and any medications they are taking) and customize the notifications they receive from the program.
Resources: This page provides links to Web-based resources that contain extra information and tips about changing health risk behaviors.
Emergency: This page provides contact details for relevant helplines. Participants are instructed to contact one of these services or contact emergency services if they are thinking about suicide or experiencing a personal crisis.
MyHealthPA was developed as a responsive website (as opposed to a native and downloadable app) optimized for use on a mobile phone, but that also allowed users to view the program on any device with internet access.
Interest in addressing specific health issues via a mobile phone.
Health issue | History of mental illness, current distressa (N=48), n (%) | History of mental illness, no |
No mental illness, current |
No mental illness, no |
Diet | 23 (48) | 30 (55) | 3 (38) | 37 (47) |
Physical activity | 29 (60) | 37 (67) | 5 (63) | 45 (57) |
Cardiovascular disorder | 7 (15) | 16 (29) | 1 (13) | 16 (20) |
Smoking | 9 (19) | 6 (11) | 1 (13) | 4 (5) |
Alcohol use | 7 (15) | 12 (22) | 1 (13) | 4 (5) |
Mood | 31 (65) | 33 (60) | 5 (63) | 18 (23) |
Mental health | 35 (73) | 41 (75) | 7 (88) | 30 (38) |
aDistress: psychological distress.
Screenshots of the MyHealthPA program.
To evaluate the feasibility and potential efficacy of MyHealthPA, particularly among people with mental health problems, a pilot study was conducted among young people with and without a previous diagnosis of a mental illness. The pilot study used a pre-post design. Participants were recruited via flyers placed on university campuses, paid and unpaid advertisements on social media (eg, Facebook or Twitter), and on the institution website of the lead author.
Potential participants were asked to complete an initial Web-based screening questionnaire. To be eligible, participants were required to be aged 18 to 25 years, live in Australia, and have access to a mobile phone with internet access. Upon meeting eligibility criteria, participants were asked to provide informed consent and complete a Web-based baseline assessment. They were then given access to the MyHealthPA program for a period of 8 weeks, after which they were asked to complete a Web-based end-of-treatment assessment and a Web-based follow-up assessment 1 month later (12 weeks after baseline). All Web-based assessments were hosted by Survey Monkey.
The baseline assessment contained items regarding demographic characteristics; medical history, including if they had ever been diagnosed with a mental illness; frequency of mobile phone use; use of mobile health apps; current health behaviors; and current psychological distress (using the 4-item version of the PHQ 4) [
The health behaviors measured were smoking (smoking status and cigarettes per day), alcohol use (Alcohol Use Disorders Identification Test—Consumption items, AUDIT-C [
Health behaviors and current psychological distress of participants were also assessed at end of treatment and follow-up. In addition, as a part of the end-of-treatment assessment, participants were asked to answer a series of questions related to the usability and acceptability of MyHealthPA, which included the System Usability Scale (SUS) [
A total of 102 participants completed the initial Web-based screening questionnaire. Of these, 35 (35/102, 34.3%) were eligible to participate and provided informed consent; however, 7 (7/35, 20%) did not complete the Web-based baseline questionnaire, leaving a total of 28 (28/35, 80%) participants who were included in the pilot study and granted access to the MyHealthPA program. A total of 12 (12/28, 43%) participants also completed the end-of-treatment Web-based assessment, and 6 (6/28, 21%) participants completed the follow-up assessment 1 month later.
A total of 12 (12/28, 43%) participants reported that they had previously been diagnosed with a mental illness. Descriptive statistics are reported separately for participants with and without a history of mental illness. Of these, 9 (9/12, 75%) participants reported having previously been diagnosed with depression, 9 (9/12, 75%) with anxiety, 2 (2/12, 17%) with an eating disorder, 2 (2/12, 17%) with a bipolar disorder, and 1 (1/12, 8%) with a borderline personality disorder. As shown in
Both groups of participants described frequent mobile phone use. All participants used their mobile phone every day, and most of them used it at least once every hour (history of mental illness = 9/12, 75%, no history of mental illness = 12/16, 75%). Most participants (history of mental illness = 11/12, 92%, no history of mental illness = 12/16, 79%) had also previously used their mobile phone to look for health or medical information or track health and fitness data, with many reporting they did so on a weekly or daily basis (history of mental illness = 6/12, 50%, no history of mental illness = 5/16, 31%). The majority of participants also reported having a range of health apps installed on their mobile phone, particularly exercise (history of mental illness = 8/12, 67%, no history of mental illness = 9/16, 56%), diet (history of mental illness = 11/12, 92%, no history of mental illness = 14/16, 88%), sleep (history of mental illness = 67%, no history of mental illness = 31%), and mood apps (history of mental illness = 50%, no history of mental illness = 13%). However, most participants with these apps installed on their mobile phone reported rarely using them (history of mental illness = 5/12, 42% to 12/12, 100%, no history of mental illness = 11/16, 69% to 16/16, 100%).
Participant characteristics at baseline.
Characteristics | History of mental illness (N=12) | No history of mental illness (N=16) | |
Age (years), range | 19-25 | 18-25 | |
Age (years), mean (SD) | 21.2 (2.1) | 21.81 (2.3) | |
Gender (female), n (%) | 10 (83) | 10 (63) | |
Lesbian, gay, bisexual, and transgender, and intersex, n (%) | 6 (50) | 1 (6) | |
ATSIa, n (%) | 0 (0) | 0 (0) | |
Defacto | 1 (8) | 1 (6) | |
Never married or single | 11 (92) | 15 (94) | |
Born in Australia, n (%) | 9 (75) | 14 (88) | |
First language other than English, n (%) | 1 (8) | 3 (19) | |
High school (Grade 11-12) | 9 (75) | 9 (56) | |
University degree | 3 (25) | 7 (44) | |
Employed (full or part time and casual) | 2 (17) | 4 (25) | |
Student | 9 (75) | 9 (56) | |
Unemployed | 0 (0) | 1 (6) | |
Other | 1 (8) | 2 (13) | |
At risk—alcohol | 5 (46) | 5 (33) | |
At risk—smoking | 1 (14) | 2 (13) | |
At risk—diet | 12 (100) | 15 (100) | |
At risk—physical activity | 5 (46) | 6 (40) | |
Lifestyle Risk Index, mean (SD) | 1.90 (0.57) | 1.86 (0.92) | |
PHQ 4b, mean (SD) | 5.67 (2.96) | 2.60 (2.07) |
aATSI: Aboriginal and Torres Strait Islander.
bPHQ 4: 4-item Patient Health Questionnaire.
As can be seen in
The 12 participants who completed the end-of-treatment assessment reported that MyHealthPA had average usability. The mean SUS scores were 67.1 among participants without a history of mental illness and 64.5 among those with a history of mental illness, with a slight majority (history of mental illness = 4/7, 57%, no history of mental illness = 3/5, 60%) reporting the MyHealthPA program had above-average usability (as indicated by a score of 68 or more on the SUS [
When participants were asked what aspects of MyHealthPA they felt did not work well, a key theme of
Similarly, participants found it difficult to remember to access the program regularly:
I found it difficult to remember to use it every day—in fact I completely forgot about it until I got the email to do this survey. A phone app with daily reminders would be a good idea.
The length of the adverse symptoms questionnaire was also cited as a barrier to use, and 1 participant without a history of mental illness questioned the simplicity of the program: “Maybe a bit TOO simple—didn’t really see the point in using it.”
Participants’ use of MyHealthPA.
MyHealthPA use | Mean (SD) | Range | |||
Number of days accessed MyHealthPA | 3.17 (8.47) | 0-30 | |||
Number of times access MyHealthPA | 6.42 (13.69) | 0-39 | |||
Number of pages access | 5.0 (11.49) | 0-41 | |||
Number of diary entries | 9.50 (20.59) | 0-54 | |||
Number of goals set | 0.25 (0.62) | 0-2 | |||
Number of days accessed MyHealthPA | 4.31 (6.75) | 0-24 | |||
Number of times access MyHealthPA | 7.13 (11.79) | 0-38 | |||
Number of pages access | 11.25 (14.59) | 0-44 | |||
Number of diary entries | 10.0 (16.56) | 0-54 | |||
Number of goals set | 0.75 (1.07) | 0-3 |
Attrition among MyHealthPA users.
System Usability Scale scores.
System usability scale | History of mental illness (N=5), n (%) | No history of mental illness (N=7), n (%) | |
Strongly disagree | 1 (20) | 0 (0) | |
Disagree | 1 (20) | 3 (43) | |
Neutral | 1 (20) | 2 (29) | |
Agree | 1 (20) | 2 (29) | |
Strongly agree | 1 (20) | 0 (0) | |
Strongly disagree | 2 (40) | 0 (0) | |
Disagree | 2 (40) | 3 (43) | |
Neutral | 1 (20) | 2 (29) | |
Agree | 0 (0) | 2 (29) | |
Strongly agree | 0 (0) | 0 (0) | |
Strongly disagree | 0 (0) | 0 (0) | |
Disagree | 0 (0) | 0 (0) | |
Neutral | 2 (40) | 3 (43) | |
Agree | 3 (60) | 3 (43) | |
Strongly agree | 0 (0) | 1 (14) | |
Strongly disagree | 1 (20) | 4 (57) | |
Disagree | 3 (60) | 1 (14) | |
Neutral | 0 (0) | 2 (29) | |
Agree | 0 (0) | 0 (0) | |
Strongly agree | 0 (0) | 0 (0) | |
Strongly disagree | 0 (0) | 0 (0) | |
Disagree | 1 (20) | 1 (14) | |
Neutral | 1 (20) | 2 (29) | |
Agree | 1 (20) | 4 (57) | |
Strongly agree | 0 (0) | 0 (0) | |
Strongly disagree | 0 (0) | 2 (29) | |
Disagree | 4 (80) | 1 (14) | |
Neutral | 1 (20) | 4 (57) | |
Agree | 0 (0) | 0 (0) | |
Strongly agree | 0 (0) | 0 (0) | |
Strongly disagree | 0 (0) | 0 (0) | |
Disagree | 0 (0) | 0 (0) | |
Neutral | 3 (60) | 1 (14) | |
Agree | 2 (40) | 3 (43) | |
Strongly agree | 0 (0) | 3 (43) | |
Strongly disagree | 0 (0) | 2 (29) | |
Disagree | 2 (40) | 1 (14) | |
Neutral | 1 (20) | 3 (43) | |
Agree | 1 (20) | 1 (14) | |
Strongly agree | 1 (20) | 0 (0) | |
Strongly disagree | 0 (0) | 0 (0) | |
Disagree | 0 (0) | 1 (14) | |
Neutral | 3 (60) | 2 (29) | |
Agree | 1 (20) | 2 (29) | |
Strongly agree | 1 (20) | 2 (29) | |
Strongly disagree | 1 (20) | 3 (43) | |
Disagree | 3 (60) | 2 (29) | |
Neutral | 1 (20) | 2 (29) | |
Agree | 0 (0) | 0 (0) | |
Strongly agree | 0 (0) | 0 (0) |
When asked what they thought worked well about the program, the primary theme mentioned by participants was simplicity and ease of use of MyHealthPA. Participants liked the simple interface, how easy the program was to use, and how quickly users could enter their information, saying, “It’s easy to use, it works well on mobile, and doesn’t take much time.”
Participants also enjoyed being able to track and view their health behaviors and mood and how they interacted over time as highlighted by the following participant with a history of mental illness:
Could easily track my progress and see how my lifestyle had changed. It also made me aware of what I was eating, because I didn’t eat many vegetables or fruit before, but when I wrote it down I became aware of how unhealthy my lifestyle was. I found it interesting that when I started eating healthier and exercising a little bit more, my mood increased quite dramatically.
Finally, the key changes to the MyHealthPA program recommended by the participants were converting the program to a native app format and allowing continual log-in. Other suggestions included adding a calendar view of diary entries, allowing information from other health tracking apps to be integrated into MyHealthPA, providing more (but customizable) reminders to use the program, and providing extra information such as recipe and exercise ideas.
As can be seen in
Participants with a history of mental illness also maintained their LRI score at end of treatment and improved it by follow-up. On the other hand, a slight increase in mean LRI among people without a history of mental illness was observed at end of treatment. Specifically, as can be seen in
Change in health behavior and mood outcomes between baseline, end of treatment, and follow-up.
Outcome measures | Baseline to end of treatment, mean change (SD) | Baseline to follow-up, mean change (SD) | ||
History of mental illness (N=5) | No history of mental illness (N=7) | History of mental illness (N=5) | No history of mental illness (N=1) | |
AUDIT-Ca score | 0.00 (1.73)b | 2.14 (1.86) | −1.00 (1.73)b | 4.0 (N/Ac) |
No. of cigarettes per day | 0.00 (0.00)b | 1.50 (2.12) | 0.33 (0.58) | N/A |
No. of fruit and vegetables per day | 0.50 (1.00)b | 0.71 (1.38)b | 1.0 (1.58)b | 3.0 (N/A)b |
IPAQd score | 864.60 (1104.83)b | 745.5 (1555.13)b | 1518.20 (1162.87)b | 1523.5 (N/A)b |
PHQ 4e | −1.4 (4.51)b | 0.29 (3.73) | −2.4 (2.88)b | 0 (N/A)b |
LRIf | 0.00 (0.00)b | 0.14 (0.89) | −0.40 (0.89)b | 0.00 (N/A)b |
aAUDIT-C: Alcohol Use Disorders Identification Test–consumption items.
bChange in desired direction or no change.
cN/A: not applicable.
dIPAQ: International Physical Activity Questionnaire.
ePHQ 4: 4-item Patient Health Questionnaire.
fLRI: Lifestyle Risk Index.
Change in Lifestyle Risk Index.
Change in risk behaviors | Baseline to end of treatment | Baseline to follow-up | ||
History of mental illness (N=5), n (%) | No history of mental illness (N=7), n (%) | History of mental illness (N=5), n (%) | No history of mental illness (N=1), n (%) | |
Change of −1 | 0 (0) | 1 (14) | 3 (60) | 0 (0) |
No change | 5 (100) | 5 (71) | 1 (20) | 1 (100) |
Change of +1 | 0 (0) | 0 (0) | 1 (20) | 0 (0) |
Change of + 2 | 0 (0) | 1 (14) | 0 (0) | 0 (0) |
The results of the initial pilot study of the MyHealthPA program suggest that MyHealthPA is an acceptable, easy-to-use tool that may help people to reduce key health risk behaviors associated with CVD, especially people with mental health problems. Although only a slight majority of participants thought the program had above-average usability, most participants described it as easy to use. Unlike previous literature that has found difficulty using diary features to be a common criticism of health apps [
The pilot study had a number of limitations, including the use of self-report measures only, which meant that participant characteristics and results were unable to be independently validated. As such, these results should be interpreted with a degree of caution. Another key limitation was the high rate of participant dropout between the baseline, end-of-treatment, and follow-up assessments. Participants did not receive any incentives or compensation for completing each of the assessment points beyond receiving an extra entry into a draw to win an iPad. In previous research conducted by the research team that has achieved much higher follow-up rates, an incentive of Aus $20 to Aus $50 per assessment has been offered to participants. Unfortunately, resource limitations meant that similar incentives were unable to be offered in this pilot study. This lack of incentive may have been responsible for the low follow-up rates observed, highlighting the potential importance of incentives or compensation for participation in this kind of research.
In addition, despite receiving reminders to access the program after 2 and 5 days of inactivity, large proportion of participants never accessed MyHealthPA or accessed the program on only a few occasions. For example, out of a possible 56 days on which participants could have accessed the program, the maximum number of days the program was accessed was 30, with a mean of just under 4 days. In this way, their minimal use mirrored their SUS responses, which indicated few participants would like to use MyHealthPA frequently, as well as their reported patterns of use of other health apps and other mobile health trials [
Finally, these results may need to be interpreted with caution, as the participants recruited to this pilot study may not be representative of the wider population of people with experience of mental health problems. Participants with a history of mental illness in this pilot were highly educated and mostly studying or employed. Despite these limitations, these initial results are promising. Further testing of the efficacy of the MyHealthPA program, including determining the optimal way to integrate this program into existing clinical and public health care, is warranted.
The aim of this study was to describe the formative research and process of planning that formed the development of the MyHealthPA program. MyHealthPA was developed to address the need for scalable and effective interventions to address the risk of CVD among people with mental health problems that are of low burden to both clinicians and consumers. MyHealthPA is unique, as it targets the top 4 behavioral risk factors associated with CVD (smoking, alcohol misuse, physical inactivity, and poor diet), which are also extremely common among people with mental health problems, while also addressing mood and the way in which mood and psychiatric symptoms might interact with these health behaviors. Although many apps purporting to help users improve their health have been developed for use by the general population, MyHealthPA is the first to specifically target people with mental health problems and aims to help them improve their health behaviors and decrease their cardiovascular risk. The program was designed to employ evidence-based techniques, such as self-monitoring, goal setting, and addressing multiple health behaviors simultaneously [
The design process employed to develop MyHealthPA was time and resource efficient. A key strength was the inclusion of a range of perspectives (ie, expert researchers, clinicians, and potential end users) in the design process via the scoping survey and review of the of the written content and beta version of the app. Additional focus or laboratory-based testing (eg, using a think-aloud protocol [
Overall, the MyHealthPA program represents an innovative approach to CVD risk reduction among people with mental health problems. It appears that MyHealthPA is acceptable, easy to use, and potentially effective. A large-scale clinical trial employing MyHealthPA in groups of people with mental health problems is indicated.
Alcohol Use Disorders Identification Test–consumption items
cognitive behavioral therapy
cardiovascular disease
Flat Explicit Design Model
Specific, Measurable, Active, Realistic, and Time-limited
System Usability Scale
Lifestyle Risk Index
4-item Patient Health Questionnaire
This study was funded by LT’s University of New South Wales Vice-Chancellor Post-Doctoral Fellowship. The authors would also like to acknowledge the work of Greg Stephenson and his team at NetFront to develop the MyHealthPA program.
None declared.