Development and usability testing of OSI: Online Support and Intervention for child anxiety (Preprint)

BACKGROUND Online treatments for child anxiety may help increase access to evidence-based therapies, however user engagement, uptake and adherence within routine clinical practice remains a challenge. Involving the intended end users in the development process through co-design and usability testing is argued to be crucial for maximising user engagement and adoption of online treatments, but so far this has been lacking for online treatments for child anxiety. OBJECTIVE To develop an online treatment for child anxiety through a process of co-design (Phase 1) and usability testing (Phase 2), based on an existing evidence-based face-to-face therapist-supported, parent-led CBT intervention. It was intended that the online version of this treatment would consist of a parent website, case management system for clinicians and mobile game application for children. METHODS Parents, children and clinicians who were familiar with the face-to-face version of the treatment were recruited from 2 NHS clinics. In Phase 1, participants took part in 3 workshops to gain feedback on the overall concept, explore their wants and needs for the websites/game, generate ideas on how the treatment may look and gain feedback on initial mock-ups of the websites/game. In Phase 2, participants attended 3 individual usability testing sessions where they were presented with working prototypes of the websites/game and asked to carry out a series of tasks on the website (parents/clinicians) or play the game (children). The frequency and detail of usability errors was recorded. Participants were asked for their feedback on the website/game using a standardised usability questionnaire and semi-structured interviews. The websites/game were iterated after each round of usability testing in response to this feedback. RESULTS In Phase 1, participants approved the general concept and rated the initial mock-ups of the website/game positively. In Phase 2, working prototypes were rated positively and usability errors declined across the iterations and were mainly cosmetic or minor issues relating to aesthetic preference, with few issues regarding ability to navigate the website or technical issues affecting functionality. Feedback from the semi-structured interviews further supported the positive response of participants to the website/game and helped identify areas for improvement during the iteration process. The final iteration of the website/game is presented. CONCLUSIONS Taking an iterative approach to development through co-design and usability testing has resulted in an online treatment for child anxiety (OSI: Online Support and Intervention for child anxiety) that appears to meet the needs and expectations of the intended users (parents, children and clinicians), and is easy and enjoyable to use.