A mixed methods study on user acceptability of STOP: a digital mental health intervention for paranoia.

Background: Cognitive bias modification for interpretation (CBM-I) is a technique to modify interpretation and used to reduce unhelpful negative biases. CBM-I has been extensively studied in anxiety disorders where interpretation bias has been shown to play a causal role in maintaining the condition. STOP (Successful Treatment of Paranoia) is a CBM-I digital smartphone app targeting interpretation bias in paranoia. It has been developed following research on the feasibility and acceptability of a computerized version. The current qualitative study extended that research by investigating the acceptability of STOP in individuals with paranoia. The study design and implementation were informed by the Evidence Standards Framework for Digital Health Technologies (DHTs) provided by the National Institute for Health and Care Excellence (NICE). Objective: The aim of the study was to involve service users in the design, development and testing of the smartphone app STOP and understand the degree of satisfaction with the current product. We aimed to establish the extent to which STOP met the NICE minimum and best practice standards for DHTs, specifically its acceptability to intended end users. Method: Twelve participants experiencing mild to moderate levels of paranoia completed six weekly sessions of STOP before being invited to a feedback interview to share their experiences. Questions revolved around the acceptability of the application, perceived usefulness and barriers of the intervention as well as practicality and views around the use of a digital intervention in principle. Interviews were coded and analysed using the Framework analysis method to combine a deductive and inductive approach. Results: Framework analysis yielded six themes: STOP as an autonomous treatment; comparisons to other treatment options; the user experience of STOP (i.e. feelings towards and perceived usefulness of STOP); perceived impact on personal outcomes; design considerations (including recommendations for improvement); and therapeutic aspects of the core intervention. Conclusions: STOP is a broadly acceptable intervention that was positively received by most participants. The current study findings are in line with the NICE Evidence Standards Framework for DHTs in that intended end users were involved in the development, design and testing of STOP and were mostly satisfied with it. These findings will contribute to the further iterative development of this intervention targeting interpretation bias in paranoia. Trial Registration: https://doi.org/10.1186/ISRCTN17754650