Table 6.
Feedback from User Testers and Associated Adaptations to the Intervention and Mobile Application
| Theme | Paper intervention materials (N = 5) |
Mobile application (N = 5) |
||
|---|---|---|---|---|
| Participant comments | Adaptations | Participant comments | Adaptations | |
| Suggestions for improving relevance to the population | 1. Use less formal language 2. Provide additional YA-specific examples when presenting skills 3. Many YAs feel alone in their experience; provide opportunities to normalize their experiences |
1. More informal language was used (e.g., skills/strategies vs. exercises) 2. Examples of a change: others in life “don't get it”; YA-relevant example questions to ask your provider about symptoms 3. Added language in the therapist manual normalizing their experiences (e.g., normalize grief over legacy lost or changed); provided additional opportunities for group members to share their experiences |
1. Would be nice to “gamify” the app and have components that were more fun and “less clinical” 2. Provide session summaries to help patients who may need to miss the group due to competing responsibilities or for those who have lingering changes to memory |
1. Participants receive within-app badges for completing home-practice activities 2. Summaries were created for each of the sessions |
| Suggestions for improving intervention structure/format/layout/usability | 1. Restrict group size to ≤5 participants 2. Provide reminders in the paper manual of ways in which the mobile app can be used to reinforce skills discussed in group |
1. Structure the program to have five participants per group 2. Additional reminders about the use of the mobile application were added to the therapist and patient manuals |
1. Improve accessibility of intervention strategies 2. Group exercise videos with pictorial descriptions of the exercises 3. Divide links to resources by topic areas 4. Help participants understand differences in the app interface for iPhone and Android operating systems 5. Break text into bullet points |
1. Added folders presenting strategies and review of strategies by session number and by topic (e.g., relaxation and meditation exercises) 2. Separate folders were created presenting the videos with their pictorial descriptions 3. Separate folders were created grouping resource links by category (e.g., resources for work and school) 4. Provided information to participants in the group about what to expect based on their phone/Tablet operating system 5. Some text was placed into bullet form rather than paragraph form |
| Suggestions for improving content and use of intervention skills | 1. Did not connect with one of the distancing strategies (i.e., Carry Cards) 2. Not all strategies presented may resonate with every patient 3. Some content was confusing (e.g., biopsychosocial model, monsters on the bus) when participants were not given a full description 4. Provide a clearer link to how skills may map on to one another 5. Provide information about institution-specific resources for YA survivors |
1. The Carry Cards strategy was removed 2. Include information in the therapist manual alluding to providing survivors with a menu of coping skills they can choose from 3. Additional text was added to the therapist manual to ensure clear description of the skill or skill rationale 4. Provided a description in the therapist manual of how skills may be linked (e.g., values-based goal setting and building meaning; creating a plan to maintain progress and setting SMART goals; using mini-relaxation practices to manage emotions before communicating with others) 5. Institution-specific resources (e.g., AYA and oncofertility programs) were added |
1. Provide push notifications to complete home-practice exercises and other intervention-related tasks 2. Be able to review and edit home practice exercises |
1. Push notifications were added at regular intervals to promote home practice 2. Added this the ability to review and edit home practices in a “history” section of the app |
| Recommendations for improving the program | 1. Have the program feel conversational rather than didactic in nature and provide additional opportunities for YAs to learn from one another 2. Limit and define what was expected of participants' home practice |
1. Emphasized and added additional opportunities for group discussion around survivors' experiences and skill use 2. Provide additional description of home practice activities and time commitment |
1. Change language to reflect actions participants can take to improve symptoms | 1. Example of a change: “Connecting with sources of meaning” and “Coping with change in meaning” vs. “Coping with meaning lost” |
AYA, adolescent and young adult.