Table 2.
Summary of adolescent feedback generated during usability testing cycles that was incorporated into MindClimb.
| App feature and feedback | Changes applied | |
| Security and privacy |
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Cycle 1: password protection is important | Incorporated an option for the user to create a PINa that must be entered each time the app is opened |
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Cycle 2: “a password to get into the app or ladders” | Syncing of events with main calendar is optional |
| Notifications |
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Cycle 1 generated varied feedback on the frequency of user notifications, including wanting daily reminders, reminders 1 to 2 times per week, and notifications after a period of 1 to 2 weeks of inactivity | Added single “We’ve missed you!” notification to pop up after 1 week of having not used the app |
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Cycle 2: alerts were described as sometimes overwhelming and stressful. Adolescents wished for an option to turn off notifications | Users will receive 1 notification alert when their event is scheduled to occur |
| Step ladder creation and management |
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Cycles 1 and 2: a scale of 1 to 10 to rate the difficulty of exposure activities is more appropriate than 1 to 5 | Difficulty scale for exposure activities changed to 1 to 10 |
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Cycle 2: adolescents wanted the option to complete an exposure activity several times before proceeding to the next step in their ladder | Added the ability to repeat an event |
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Cycle 2: scheduling specific dates and times for each exposure activity might be difficult to plan; app should allow users to “opt out of dates” and dates should not be mandatory | Selection of dates for exposure activities is optional |
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Cycle 2: adolescents wanted ability to change the order of exposure activities and an easy way to “move the steps around” | Exposure activities, regardless of difficulty rating, can be rearranged by dragging and dropping |
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Cycle 2: adolescents wanted the ability to not have a coping strategy attached to an exposure activity | Activities can be created without selecting a coping strategy |
| Positive reinforcement and rewards |
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Cycle 1: “Quotes would be good. Ones that make you smile more or positivity”; creatures were a popular reward, especially the ability to upgrade characters; “increase the content” that the monster character says | Incorporated random short positive messages provided by the monster characters at various points within app |
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Cycle 2: adolescents wanted monster characters to relate quotes to them; “it’s fun to use, but the point system doesn’t do anything right now. If the points system unlocked another guy (character)” | Added 3 additional monster characters (total of 4) that can be unlocked for completing activities within the app |
| Positive self-talk |
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Cycle 2: adolescents wanted to be able to record “own memo (voice), positive self-talk” | Allow users to record their own positive self-talk messages and replay them during exposure activities |
| Relaxation techniques and thinking traps |
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Cycle 1: adolescents wanted a voice that could walk them through the relaxation techniques | Added voice narration and video as a way for users to access selected relaxation techniques during events |
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Cycles 1 and 2: too much text on deep breathing and thinking traps | Text edited for length and clarity |
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Cycle 2: techniques learned in CBTb are not in the app | Added “acting as if” relaxation techniques |
aPIN: personal identification number.
bCBT: cognitive behavioral therapy.