Adaptation and Acceptability of a Low-Intensity Cognitive Behavioral Therapy App to Support Low Mood and Worry Management in Female Forces Veterans: Mixed Methods Study.

Background: Mental health help-seeking barriers experienced by female forces veterans result in them being underserved and underrepresented. Efforts are therefore required to adapt interventions for female veterans to enhance acceptability and maximize engagement. Given a smaller number and wider geographical distribution of female veterans, targeting adaptation efforts at a digital mobile phone app based on cognitive behavioral therapy (CBT) has potential for greatest impact to improve access to a scalable evidence-based psychological therapy. Objective: This study aimed to examine the adaptation of a low-intensity CBT app to support low mood and worry management in female forces veterans and examine acceptability and usability. Methods: Using a mixed methods methodology, this study comprises a focus group of female forces veterans to inform adaptation with extracted themes used as the basis of an adaptation framework. Following adaptation, a wider sample of female veterans was recruited to use the app and complete the mHealth App Usability Questionnaire to determine acceptability, usability, and usefulness. Results: Two main areas were identified as requiring adaptation to maximize acceptability and usability. While using imagery and quotes to reflect the armed forces was initially found helpful to initiate engagement, it was considered that continued reference to the armed forces should be dropped when progressing through the app. Most app features were found acceptable; however, adaptations were requested to the content and structure of signposting information, navigation, and the way progress was monitored. No adaptations were required, however, regarding the CBT techniques used, with specific app features motivating engagement. Following the adaptation, there were good levels of acceptability, usability, and usefulness. Conclusions: Involving female forces veterans as part of an intervention adaptation process has promise to improve acceptability and engagement with a digital CBT mobile phone intervention. Ensuring that the intervention represented the transition from serving to female forces veteran is of particular significance in enhancing acceptability.