Caisa Öster

BACKGROUND Mobile research apps are increasingly used in mental health studies to enable multimodal data collection, including self-report, passive smartphone data, and digital behavioral assessments. However, ensuring usability and sustained engagement remains a challenge. User expectations, shaped by commercial apps, often conflict with research constraints, making it difficult to design research-driven apps that balance usability with scientific rigor. Applying user-centered design (UCD) principles can help address these challenges, but their role in optimizing research apps, especially those used in studies involving varied data protocols, requires further evaluation. OBJECTIVE This study aimed to document the UCD process used in developing a mobile research app for young people’s mental health (the UPIC app), assess its usability post-implementation, and provide insights for future research app developers and study designers. METHODS A UCD approach was applied, involving a series of design workshops with young people aged 15–29 to co-design the app’s interface, including early drafts of visual layout and wording. Iterative design modifications were made based on participant feedback. Following development, a usability test was conducted with 10 participants using iOS and Android devices. Participants completed task-based usability evaluations while using the think-aloud method, followed by semi-structured interviews, and the User Experience Plus (UEQ+) questionnaire. Qualitative data were analyzed using qualitative content analysis; quantitative data focused on task performance metrics and user experience scores. RESULTS User involvement contributed to improvements in interface aesthetics, navigation, accessibility, and clarity of wording. Usability testing identified remaining issues related to system feedback, survey tracking, and interaction clarity. Some user- suggested features, such as enhanced survey progress tracking and engagement elements, were only partially implemented due to feasibility constraints and concerns about data integrity. Participants evaluated the app positively in terms of trustworthiness and ease of learning, as reflected in UEQ+ scores, while ratings for engagement and novelty were lower. CONCLUSIONS While UCD improved interface usability, findings highlight the importance of combining user involvement with early, real-world usability testing to identify persistent issues. Balancing usability best practices with research constraints requires transparent communication of study design, ethical engagement strategies, and structured usability evaluations. Future research app development studies should integrate iterative UCD to support both user experience and data quality. CLINICALTRIAL ClinicalTrials.gov (UU20230127; NCT: NCT06490120)

Introduction: Patient experiences of recovery‐oriented nursing practices in psychiatric inpatient care are understudied. Steps Towards Recovery (STR) is a nursing‐led programme developed to promote personal recovery through empowering each patient's ability to identify resources, find solutions and gain control over one's life. Aim: The aim was to evaluate patients' experiences of participating in STR. Method: Interviews with 18 patients participating in STR group sessions at a psychiatric inpatient clinic. Data were inductively analysed with applied thematic analysis. Results: Three themes were identified. STR group sessions, with the manual‐based contents, seem beneficial for taking the first steps towards a personal recovery process. Participants described an increased ability to see things from different angles, could focus their thoughts more positively, and underlined the importance of maintaining these strategies after discharge. Group leaders' skills related to psychiatric inpatient care were also reflected on. Discussion: STR seems to promote personal recovery. Psychiatric inpatient care requires group leaders trained in STR with competence to manage advanced psychiatric nursing care. Limitations: Data were collected at one clinic, decreasing transferability. Implications: Recovery‐oriented programmes in psychiatric wards can support patients' first steps towards recovery. Recommendations: Nursing‐led programmes supporting personal recovery should be implemented in psychiatric wards.

Aim: To explore how factors in the complex aortic surgical care context can affect care provision towards patients' postoperative recovery. Design: Secondary qualitative analysis. Methods: Results about patients' recovery after complex aortic surgery was presented in focus groups with healthcare professionals in 2022. Reflexive thematic analysis, using the Fundamentals of Care framework, was conducted to explore contextual factors affecting care provision. Results: Healthcare professionals' descriptions resulted in one main theme: Care provision is challenged by discrepancies in values, goals and norms and unclear responsibilities within the context , and two subthemes: Values, goals and norms determine what care is provided; Taking responsibility for care requires resources, evaluation and feedback . Conclusion: Healthcare professionals describe care provision as affected by a dynamic integration of contextual factors. Healthcare professionals need to be made aware of their own role in this context. Care provision needs to be guided by feedback from patients and healthcare professionals, and work with patients' resources at both an individual, system and societal level. Implications for the Profession: The results provide knowledge regarding how contextual factors in dynamic integration can affect care provision in a complex surgical context. Healthcare professionals, leaders and policy makers all have responsibility to focus on patients' values and goals, and empower adequate care through feedback loops and resource management. Impact: The context‐of‐care dimension of the Fundamentals of Care framework has been scarcely described. Our results illustrate how an integration of factors affects care provision, where values, goals, and norms affect what care is provided, and responsibility for care belongs to everyone in the care system. The results can contribute to the description of the context‐of‐care dimension within the framework and enable professionals to understand how they, as part of the context, could affect care towards patient recovery. Reporting Method: This study adhered to the Equator research reporting checklist: Consolidated criteria for reporting qualitative research: a 32‐item checklist for interviews and focus groups. Patient or Public Contribution: No patient or public contribution.

We aimed to explore how specialist nurses and psychiatrists perceive and conceptualize their own responsibility and autonomy in relation to interprofessional colleagues when caring for inpatients with deliberate self-harm. Eight psychiatrists and 10 nurses were interviewed. The interviews underwent thematic analysis by an interdisciplinary group of experts in ethics, law, mental health nursing, and psychiatry. Three themes were found. The first theme focused on role-specific tasks and perceived responsibility. Psychiatrists more often emphasized the legal perspective and specialist nurses the ethical perspective. The second theme was to adapt to other professionals' opinions. When someone else had made a decision, autonomy was perceived to decrease, whereas responsibility increased. The third theme was renunciation of autonomy for achieving cooperation. It was considered important to strive for consensus in the team. Both nurses and psychiatrists believed they had a high degree of autonomy and responsibility when their roles were well-defined. The respondents considered clear roles, good communication, shared expectations, and mutual respect to be prerequisites for interprofessional collaboration in hospital care of patients with deliberate self-harm.

Background: Perinatal depression affects a significant number of women during pregnancy and after birth, and early identification is imperative for timely interventions and improved prognosis. Mobile apps offer the potential to overcome barriers to health care provision and facilitate clinical research. However, little is known about users’ perceptions and acceptability of these apps, particularly digital phenotyping and ecological momentary assessment apps, a relatively novel category of apps and approach to data collection. Understanding user’s concerns and the challenges they experience using the app will facilitate adoption and continued engagement. Objective: This qualitative study explores the experiences and attitudes of users of the Mom2B mobile health (mHealth) research app (Uppsala University) during the perinatal period. In particular, we aimed to determine the acceptability of the app and any concerns about providing data through a mobile app. Methods: Semistructured focus group interviews were conducted digitally in Swedish with 13 groups and a total of 41 participants. Participants had been active users of the Mom2B app for at least 6 weeks and included pregnant and postpartum women, both with and without depression symptomatology apparent in their last screening test. Interviews were recorded, transcribed verbatim, translated to English, and evaluated using inductive thematic analysis. Results: Four themes were elicited: acceptability of sharing data, motivators and incentives, barriers to task completion, and user experience. Participants also gave suggestions for the improvement of features and user experience. Conclusions: The study findings suggest that app-based digital phenotyping is a feasible and acceptable method of conducting research and health care delivery among perinatal women. The Mom2B app was perceived as an efficient and practical tool that facilitates engagement in research as well as allows users to monitor their well-being and receive general and personalized information related to the perinatal period. However, this study also highlights the importance of trustworthiness, accessibility, and prompt technical issue resolution in the development of future research apps in cooperation with end users. The study contributes to the growing body of literature on the usability and acceptability of mobile apps for research and ecological momentary assessment and underscores the need for continued research in this area.

BACKGROUND Perinatal depression affects a significant number of women during pregnancy and after birth, and early identification is imperative for timely interventions and improved prognosis. Mobile apps offer the potential to overcome barriers to health care provision and facilitate clinical research. However, little is known about users’ perceptions and acceptability of these apps, particularly digital phenotyping and ecological momentary assessment apps, a relatively novel category of apps and approach to data collection. Understanding user’s concerns and the challenges they experience using the app will facilitate adoption and continued engagement. OBJECTIVE This qualitative study explores the experiences and attitudes of users of the Mom2B mobile health (mHealth) research app (Uppsala University) during the perinatal period. In particular, we aimed to determine the acceptability of the app and any concerns about providing data through a mobile app. METHODS Semistructured focus group interviews were conducted digitally in Swedish with 13 groups and a total of 41 participants. Participants had been active users of the Mom2B app for at least 6 weeks and included pregnant and postpartum women, both with and without depression symptomatology apparent in their last screening test. Interviews were recorded, transcribed verbatim, translated to English, and evaluated using inductive thematic analysis. RESULTS Four themes were elicited: acceptability of sharing data, motivators and incentives, barriers to task completion, and user experience. Participants also gave suggestions for the improvement of features and user experience. CONCLUSIONS The study findings suggest that app-based digital phenotyping is a feasible and acceptable method of conducting research and health care delivery among perinatal women. The Mom2B app was perceived as an efficient and practical tool that facilitates engagement in research as well as allows users to monitor their well-being and receive general and personalized information related to the perinatal period. However, this study also highlights the importance of trustworthiness, accessibility, and prompt technical issue resolution in the development of future research apps in cooperation with end users. The study contributes to the growing body of literature on the usability and acceptability of mobile apps for research and ecological momentary assessment and underscores the need for continued research in this area.

The continuity of mental disorders in street-working children is rarely studied. This study therefore investigated homotypic continuity, recurrence of the same disorder, and heterotypic continuity, when a new disorder follows on the previous, of mental disorders from childhood to adulthood in street-working boys from Duhok City, Kurdistan Region of Iraq. Mental disorders were assessed by structured diagnostic interviews in 40 street-working boys in 2004–2005 and again in 2021, when the participants’ mean ages were 12.1 (SD 1.8) and 29.7 (SD 2.3), respectively. Mental disorders were common; 24 participants (60%) satisfied the criteria for at least one diagnosis at baseline and 28 (70%) at follow-up. Comorbidity increased from 1.2 (SD 1.4) disorders initially to 2.5 (SD 1.8) at follow-up. Only anxiety disorders showed homotypic continuity. Depressive disorders exhibited the greatest increase over time whereas externalizing disorders exhibited a decreasing tendency. The number of mental disorders in adulthood was related to the number of mental disorders in childhood but not to the number of childhood traumas experienced, having previously worked for more than two hours per day, having worked for over two years on the streets, or having at least one dead parent as a child. Parental ratings on the Child Behaviour Check List (CBCL) from childhood were also unrelated to the number of adult disorders. More longitudinal studies with bigger samples of both genders are needed to fully evaluate the continuity of mental disorders in street-working children and to determine whether the number of mental disorders in childhood is a stronger predictor of being mentally disordered in adult life than psychosocial risk factors or experiences of internalizing or externalizing symptoms in childhood.

Borderline personality disorder (BPD) is characterized by instability in emotions, relationships, and behaviors, such as self-injury and suicidal behavior. Dialectical Behavioral Therapy (DBT) is a...

Purpose: Parents of children scheduled for surgery often experience emotional distress and anxiety. This study aimed to explore parents' experiences of hospital care after their child's craniosynostosis surgery and their perception of support during the year after discharge.Design and Methods: A purposive sample of 19 parents of 12 children with nonsyndromic craniosynostosis, who had undergone surgery, was recruited from one of two national centers in Sweden. An interview was conducted ~1 year after the child's surgery, from September 2017 to August 2018. The interviews followed a semistructured interview guide, were recorded, transcribed verbatim, and analyzed using inductive content analysis.Results: The analysis yielded six categories with subcategories as follows: (1) cared for and confident: the hospital staff was perceived as kind, professional, and reliable. (2) Alone and abandoned: sometimes, parents found it hard to initiate contact with professionals during hospitalization and after discharge. (3) The importance of information: thorough information was perceived as essential and the need for information varied during postsurgery period. (4) Feelings of worry: some parents remained worried about risks during recovery and were concerned about comorbidities and development. (5) Alright after all: parents felt that the worst part had been before surgery. (6) The need for support: parents were generally satisfied with the support offered and they often received support from family and friends, or other parents through social media/online forums.Practice Implications: Healthcare professionals must be responsive to what support parents need at different stages in the care process and be aware that parents sometimes hesitate to initiate contact and ask for help and support. Support from healthcare professionals to everyone in the follow‐up program, as a default, might be more accessible or acceptable for some parents. Providing online support from professionals should be considered and caregivers could also facilitate peer support among parents, either face‐to‐face or online.

Objectives: To explore prescribers’ understanding of what makes initial prescription of opioids become long-term opioid therapy (opioids >90 days). Methods: A qualitative research design, phenomenography, was used for this study. Fifteen attending physicians working within primary, secondary and tertiary care in Sweden in the fields of general practice, rehab medicine, orthopedic surgery, neurosurgery, or obstetrics and gynecology were purposively recruited consecutively until categorical saturation was reached. Semi-structured interviews were used for data collection. The transcripts were analyzed and categorized by two researchers. A third researcher checked for consistency between the data and the categories. An outcome space was constructed representing the logical relationship between the categories. Results: The analysis identified six categories: The addictive opioid, The deserving patient, The ignorant prescriber, The lost patient, The compassionate prescriber, and The exposed prescriber . The differences in conceptions among the categories were clarified through three main contributors related to opioid therapy: prescriber’s characteristics, patient’s characteristics, and the healthcare organization. Conclusions: Opioids were understood as being addictive with long-term use promoting a downward spiral of tolerance and withdrawal driving the pain, leading to continued prescription. Long-term opioid therapy could be justified for patients who improved in function, and who were perceived as trustworthy. Inadequate follow-up of patients, poor training in pain management and addiction medicine, personal attitudes and beliefs about opioids, a perceived professional obligation to treat patients with pain, and lack of collegial support, were factors understood to promote clinically unindicated long-term opioid therapy.