Categorizing Mental Health App Techniques

Two independent reviewers coded the apps’ incorporated techniques based on the following categories: mindfulness/meditation, tracker (including diary or journal), psychoeducation, peer support, and breathing exercise (not exercised as part of a meditation program). These categories were based on previous work done on the therapeutic components of mental health apps [27 ,30 (link)], drawing on the thematic analysis method suggested by Braun and Clarke [31 (link)]. The categories were designed to represent nonoverlapping components of potential therapeutic engagement (see Multimedia Appendix 2 for definitions of categories). Although our goal was to identify how specific techniques related to patterns of app use, our metrics did not enable us to differentiate between various techniques incorporated within the same app (ie, we could not tell which parts in the app the users were using). Therefore, we also added a coding of “primary technique” in cases where the app mostly incorporated one technique that was deemed to be the main reason for the app’s use (eg, mindfulness/meditation). It is important to note that this limitation did not enable us to include app features that might influence user engagement but were not identified as a primary incorporated technique. Similarly, it was not feasible to target specific theoretical modalities, such as cognitive behavioral therapy. Because nearly all apps included some components of cognitive behavioral therapy, these were impossible to dismantle given our data.
An app’s mental health focus was determined in the following manner: first, the app’s description had to explicitly state that it targeted people with [mental health focus] and, second, most of the techniques used within the app had to have been built to help users cope with or manage their symptoms directly related to the mental health focus. We grouped apps based on several mental health foci. Under “mental health problems,” we included apps that were focused on supporting people coping with depression, anxiety-related disorders, and emotional difficulties. We also subcoded the app with the terms (a) anxiety-related disorders or (b) depression if the app specifically targeted only one of these aims. (During our coding process, we did not identify another theme for the remaining apps.) Under “happiness,” we included apps that focused on nurturing happiness or general positivity (eg, exercising gratitude, happiness assessment, suggestions for activities nurturing positive feelings), rather than the management of mental health states or problems.
During our coding process, we found a greater ambiguity around the description of apps with a primary incorporated technique of mindfulness/meditation, which leaned more toward enhancing emotional well-being (ie, helping users achieve a positive sense of experience and good mental health), but also aimed at stress reduction. Therefore, we grouped mindfulness and meditation apps separately and did not attribute either of the two mental health foci to them. For this reason, and to enable a proper comparison between categories, we present the mindfulness/meditation category in both the mental health focus and technique outcomes, despite being the same results.
A Cohen kappa interrater agreement of .92 was obtained for coding the variables of interest (incorporated technique, primary technique, and mental health focus). All disagreements were discussed with a third author with reference to the apps until consensus was reached.