5 Design study I: How to create an ambulatory app for patients with BPP 173 6. Discussion This paper describes a study that is part of a project aimed at designing and implementing a e-coaching application on emotional awareness in the challenging environment of a psychiatric ward for patients with severe borderline personality disorder. It describes a ‘design science’ approach in which a scientifically informed UXD framework is employed in the first steps towards ambulatory biofeedback systems that will empower people in their own emotion regulation by complementing and supporting existing therapies. According to March and Smith [51], ‘design science’ consists of two basic activities: building and evaluation. With the adoption of the design science paradigm [51, 52], we constructed and simultaneously first ‘tested’ a scientifically informed approach to designing an mHealth application, using a modified UXD-framework. Practically, our goal was to establish the main requirements of an e-coach capable of improving awareness of emotional arousal in patients with borderline personality disorder. Our most important outcomes were: (1) Although the user needs of both groups regarding the proposed e-coach did converge to a considerable degree, the use of personas in the Strategy and Scope plane made clear some fundamental differences between the therapists and patients as users. (2) A detailed set of requirements for a physiologically based real-time biofeedback tool for psychiatric patients that has been acquired with the patients. (3) Detailed personas for both our patients and therapists that can form the basis of other research and design for this particular group. Below we will elaborate on the details and discuss these findings in the light of literature on treatments for BPD, effectiveness of feedback and future implementation of our proposed solutions. Although the user needs of both groups regarding the proposed e-coach did converge to a considerable degree, the use of personas in the Strategy and Scope plane made clear some fundamental differences between the therapists and patients as users. The use of personas in participatory design studies in a mental health setting is a relative novelty. Personas provide a manageable yet insightful overview of the acquired data on user needs and provide a context for easily relating gathered information to when determining design requirements [92, 93]. As therapists have less affinity with technology than patients, it is likely they will be less prone to use the future e-coaching intervention without proper adjustment to their profile. For successful implementation, therapists will have to work with patients using the e-coach and will have integrate the intervention in current therapy. Adapting the e-coaching intervention to the personal characteristics of both user groups is therefore essential.
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