Better GI
A comprehensive self-management Intervention addressing anxiety & depression among persons with irritable bowel syndrome (IBS).
Background
9-17% of individuals in the US have a diagnosis of irritable bowel syndrome (IBS).
IBS is a disorder of the brain-gut interaction and associated with recurrent abdominal pain​.
Around 50% of individuals with IBS also have co-morbid anxiety and/or depression.
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IBS patients with anxiety and depression also report more severe IBS symptoms and lower quality of life than those without.
Problem
The Comprehensive Self-Management (CSM) intervention was developed to improve quality of life and reduce abdominal pain. The CSM had been disseminated through a 230-page book which providers could use with their patients; adoption was limited due to:
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Length of manual
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Complexity
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Time needed with clinician
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​Solution
A mobile app with a 9-week self-guided intervention.
User Research:
Semi-Structured Interviews & Card Sorting
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Patient Recruitment
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Ages 18-70
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diagnosis of moderate-severe IBS
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Moderate-severe anxiety and/or depression
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​Topics
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Symptoms
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Previous experiences with related interventions
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Introduction of the CSM Intervention
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Provider Recruitment
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Gastroenterologists
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Cared for at least 3 IBS patients per month
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​Topics
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Current practice
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Introduction of the CSM Intervention​
Card Sorting
Key Findings
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Patients and providers liked the structure and accountability of the intervention.
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Patients were interested in moving through the manual at their own pace, but still have a professional to check-in with for questions.
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Patients identified main challenges as: lack of time to complete the daily assignments; lack of motivation and other personal obstacles.
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Providers identified their main challenge: lack of time to do weekly teaching sessions.
Design & Build
Redesign Goals
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Reduce provider face-to-face time.
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Improve content digestibility.
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Make the tracking (food, sleep, symptoms) more convenient and efficient.
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Create content summarizing patient behavior to facilitate communication with their provider when they meet.
App Requirements
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Onboard the user to the intervention.
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Simplify content, and focus on making learning the skills and tracking easy.
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Provide insights/data about the relationship between the user’s behavior and symptoms.
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Provide motivation to keep the users engaged for the length of the intervention.
Ideation
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Competitive analysis.
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Mapped out user flow
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Refined content in the original manual.
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Collected graphics/videos to vary content delivery, reducing amount of reading.
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We also hired an illustrator to draw pictures to go along with the content.
Prototyping
Our next step was to build out a prototype of our concept for user testing.
User Testing
Over 10 days we tested the onboarding sequence and first 3 modules using a working prototype.
Recruitment:
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8 patients, including 7 previous participants who were interviewed about the original intervention.
Insights & Findings
Onboarding
For a paced intervention, content needs to be very clear. Onboarding plays a really important role in letting the user know:
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Expectations for how they will be interacting with the app.
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The pace of the program and how to navigate the intervention content.
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How it benefits them.
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How it is designed to help manage symptoms but doesn’t replace seeing a provider.
Modules
When we asked users about the content two things came up for us to revisit:
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Content emphasis. 
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Pacing: longtime patients wanted  to jump modules. 
Overall, users were more engaged by the new app content and preferred the modules than the original paper-based format.
Tracking
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Participants were most excited about being able to track in-app and being able to look at compiled data.
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Users wanted to track more physical, mental and trigger food symptoms than we originally offered.
Reports
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Users want reports that they can share with their healthcare providers.
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Generally, users were happy with daily symptom and food reports, but would like personalized insights from tracking. For example, insights encouraging/discouraging certain food items
or practices.
Skills
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Most users thought it was reasonable to do a daily 5-15 minute skill practice.
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We discovered that users wanted the ability to check off the skills and the tracking they completed that day.
Testimonials
“Email me when it is out, I’ll be a user.”
“I honestly think this was a cool app. I enjoyed the few days I had with it and I’ve never seen anything like it or anything tailored toward IBS. It’s a pretty amazing thing. I would love to try it once it’s built with all of the modules."
“I do like that [the app] was made easy. If I can figure it out, anyone can figure it out.”
“All that together I think, packaging evidence-based tools in an easy-to-access way, is likely to be helpful to people.”
Next Steps
This study aimed to determine the anticipated acceptability, appropriateness, feasibility, and usability of a comprehensive self-management intervention using an implementation science and human-centered design approach among individuals with comorbid IBS and anxiety or depression and health care providers.
Mobile App
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Develop content for additional, optional modules.
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Incorporate the feedback from user testing to update the design (dashboard, reports, etc.) and content's language/tone.
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Develop logic needed for the app to produce insights regarding connections between behavior and symptoms experienced.
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Build out all the app screens to give to the developer.
Academic
Grant Proposal, R34, submission to NIMH:
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To develop implementation study and build and pilot the app.​
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Publications: