Development and usability evaluation of an audio-based cognitive behavioral therapy mobile app for depression in hemodialysis patients

Hemodialysis patients (HDPs) often experience depression, which negatively impacts their treatment adherence and quality of life. Drug therapy for depression in HDPs is often limited due to its effectiveness and drug safety concerns. Cognitive behavioral therapy (CBT) has emerged as a promising alternative. However, its delivery is hampered by various challenges, especially in this vulnerable population. We aimed to develop an innovative mobile application to overcome some of the challenges in delivering CBT for depression and evaluate its perceived usability among HDPs. This study was conducted in a nephrology department in a developing country between 2022 and 2023. Relevant topics were adapted into a CBT framework tailored to hemodialysis care and cultural context by a multidisciplinary expert panel including of a senior nephrologist with decades of clinical experience and a clinical psychologist before conversion into audio format for the application. Usability was assessed with 30 hemodialysis patients aged ≥ 18 years, receiving treatment for ≥ 3 months, with mild to moderate depression (Beck Depression Inventory short form (BDI-SF) score 5–15), owning Android smartphones, and possessing basic reading and writing literacy. This study focused on the development and usability evaluation of the application; clinical effectiveness was not assessed. Perceived usability was assessed using the Questionnaire for User Interface Satisfaction (QUIS). The hemodialysis-tailored CBT program comprised seven sessions aimed at addressing stress and depression in HDPs through skills such as goal setting, problem solving, and coping with negative emotions using language carefully developed and validated by clinical experts familiar with the needs and literacy levels of this population. The content was transformed into 26 audio episodes, each approximately 15 min long, delivered via a user-friendly mobile app featuring educational CBT content, therapist communication, peer support, and reporting functions. Thirty HDPs participated in the usability evaluation; they were primarily aged 50 to 65 years, had predominantly elementary-level education, and more than one year of hemodialysis experience. They expressed high satisfaction, with an average usability score of 7.87 out of 9. The application achieved high usability scores among HDPs, supporting its feasibility and perceived usability as an audio-CBT delivery platform. These findings lay the groundwork for future studies to assess its clinical efficacy, cost-effectiveness, and role in providing psychological support in real-world care settings.