Mixed-methods assessment of a guided imagery therapy mobile app prototype for treating childhood functional abdominal pain disorders

Authors: HOLLIER, JOHN - Baylor College Of Medicine; STRICKLAND, TIANTA - Baylor College Of Medicine; VAN TILBURG, MIRANDA - University Of North Carolina; SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC); Thompson, Deborah - Debbe

Submitted to: Meeting Abstract
Publication Type: Abstract Only
Publication Acceptance Date: 10/15/2021
Publication Date: 12/15/2021
Citation: Hollier, J.M., Strickland, T.A., van Tilburg, M.L., Shulman, R.J., Thompson, D.J. 2021. Mixed-methods assessment of a guided imagery therapy mobile app prototype for treating childhood functional abdominal pain disorders [abstract]. NASPGHAN Annual Meeting (Virtual). December 15, 2021.Oral presentation.

Interpretive Summary:

Technical Abstract: Functional abdominal pain disorders (FAPDs) are highly prevalent worldwide in both children and adults. Affected children experience increased psychosocial distress like anxiety and depression compared to their healthy peers. Clinical trials suggest cognitive behavioral therapy and its variants like guided imagery therapy are efficacious for FAPDs. Access to guided imagery therapy is often impeded by systemic barriers like lack of practitioners and poor mental health insurance coverage. Remotely delivered audio-recorded guided imagery therapy (ARGIT) is efficacious also so we developed a mobile application (app) prototype. The objective of this study was to capture affected children's and their caregivers' perspectives of our ARGIT mobile app prototype. 7 to 12 year old children with a FAPD and their caregiver were recruited (based on self- or proxy-reported Rome IV criteria) Exclusion Criteria: organic GI disease, significant chronic health conditions, and/or abdominal surgery. Subject demographics were collected at enrollment. Each participant separately reviewed the ARGIT mobile app. Participants were given the following tasks: (1) open the ARGIT mobile app, (2) log in, (3) play a ARGIT session, (4) set up a reminder notification time, and (5) exit the app. Each subject listened to a sample 8-1/2 minute ARGIT session. Demonstration tasks were video recorded. The Systems Usability Scale (SUS) is a 10-item questionnaire that objectively measures usability. Both affected children and their caregivers separately completed the SUS after the ARGIT app demonstration. Both affected children and their caregivers separately participated in 1-hr semi-structure interviews discussing the usability of the mobile app and general feedback regarding guided imagery therapy to treat children with FAPDs. Interviews were audio-recorded and transcribed for data analysis. Two independent reviewers (JMH and TAS) used applied thematic analysis to identify a priori and emerging codes from the transcripts. A priori codes included app usability and engagement factors. Both affected children and their caregivers had difficulty setting the session reminder feature. All other tasks were completed without difficulty. The overall app usability was favorable but difficulty setting the app's session reminder feature was noted. Logging in with a username/password was "easy." Various app engagement factors were offered. Children suggested that the app's appearance should include animations to play during the therapy sessions and incorporating more "exciting" backgrounds like nature scenes. Children preferred short 5-minute therapy sessions. For completing their therapy sessions, children preferred both tangible rewards (e.g., money and toys) and virtual prizes (e.g., points, coins, and new guided imagery therapy sessions). Preferred therapy session topics included animals, a beach setting, swimming, and rainforests/forests. Session background noise/music was preferred. The app's usability is favorable but the session reminder feature was difficult to set. The logging in process was straightforward. Engagement factor suggestions were readily offered. The app's appearance could be improved by centering text fields, increasing font sizes, and by using kid-friendly language (e.g., "audio track" is not appropriate). There was no consensus about playing animations on the app during the therapy sessions. There was no consensus on therapy session duration. App engagement by children with FAPDs would depend on guided imagery therapy session efficacy, tangible rewards, and virtual prizes. Caregivers thought a beach setting would be an ideal therapy session setting. They also recommended playing related music and nature sounds in the background during therapy sessions. There was concordance of the ARGIT app's high usability but difficulty setting its session reminder featu